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New Approaches to the Pharmacological Treatment of Anxiety and Depression

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Anxiety Disorders
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Abstract

Psychopharmacological advances in the last decade have contributed to the treatment of anxiety and depression in a number of ways. These developments have modified the conceptual framework of the biological understanding of these conditions and have led to a differentiation of subgroups of patients within the broad diagnostic categories of anxiety and depression. These more specific sub-categories are based for the most part on differences in treatment response. Psychopharmacology has also led to changes in nosology, the development of laboratory diagnostic tools, methods of response prediction and to the use of more neurochemically specific therapeutic agents. In addition to these advances, drug developments have resulted in the use of chemicals which, while maintaining initial therapeutic objectives, have fewer of the adverse effects which limited the use of the earlier compounds. In this chapter, an attempt will be made to review these developments of the last few years.

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References

  • Akindele, M. O., Evans, J. I., & Oswald, I. (1970). Monoamine oxidase inhibitors, sleep and mood. Electroencephalogram and Clinical Neurophysiology, 29, 47–56.

    Article  CAS  Google Scholar 

  • Asberg, M., Bertilsson, K., & Tuck, D. (1972). Indolamine metabolites in the cerebrospinal fluid of depressed patients before and during treatment with nortriptyline. Clinical and Pharmacological Therapy, 14, 277–286.

    Google Scholar 

  • Asberg, M., Thoren, P., & Traskman, L. (1976). Serotonin depression: A biochemical subgroup within the affective disorders? Science, 191, 478–480.

    Article  PubMed  CAS  Google Scholar 

  • Belmaker, R. H. (1981). Receptors, adenylate cyclase, depression, and lithium. Biological Psychiatry, 16, 333–350.

    PubMed  CAS  Google Scholar 

  • Bond, A. J., & Lader, M. H. (1981). Comparative effects of diazepam and buspirone on subjective feelings, psychological tests and the EEG. International Pharmacopsychiatry, 16, 212–220.

    PubMed  CAS  Google Scholar 

  • Braestrup, C., Nielsen, M., & Olsen, C. E. (1980). Urinary and brain carboline-3-carboxylates as potent inhibitors of brain benzodiazepine receptors. Proceedings of the National Academy of Science U.S.A., 77, 2288–2292.

    Article  CAS  Google Scholar 

  • Carroll, B. J. (1983). Biologic markers and treatment response. Journal of Clinical Psychiatry, 44, 30–40.

    PubMed  CAS  Google Scholar 

  • Charney, D. S., Heninger, G. R., Sternberg, D. E., Hafstad, K. M., Giddings, S., & Landis, D. H. (1982). Adrenergic receptor sensitivity in depression — Effects of Clonidine in depressed patients and healthy subjects. Archives of General Psychiatry, 39, 290–294.

    Article  PubMed  CAS  Google Scholar 

  • Chouinard, G., Young, S. N., & Annable, L. (1983). Antimanic effect of clonazepam. Biological Psychiatry, 18, 451–466.

    PubMed  CAS  Google Scholar 

  • Claycomb, J. B. (1978). Endogenous anxiety: Implications for nosology and treatment. Journal of Clinical Psychiatry, 44, 19–22.

    Google Scholar 

  • Colello, G. D., Hockenbery, D. M., Bosmann, H. B., Fuchs, S., & Folkers, K. (1978). Competitive inhibition of benzodiazepine binding by fractions from porcine brain. Proceedings of the National Academy of Science, 75, 6319–6323.

    Article  CAS  Google Scholar 

  • Cooper, A. J., & Datta, S. R. (1980). A placebo controlled evaluation of L-tryptophan in depression in the elderly. Canadian Journal of Psychiatry, 25, 386–390.

    CAS  Google Scholar 

  • Coppen, A. (1967). The biochemistry of affective disorders. British Journal of Psychiatry, 113, 1237–1264.

    Article  PubMed  CAS  Google Scholar 

  • Costa, E., & Guidotti, A. (1979). Molecular mechanisms in the receptor action of benzodiazepines. Annual Review of Pharmacology and Toxicology, 19, 531–545.

    Article  PubMed  CAS  Google Scholar 

  • de Montigny, C., Grunberg, F., Mayer, A., & Deschenes, J. P. (1981). Lithium induces rapid relief of depression in tricyclic antidepressant drug non-responders. British Journal of Psychiatry, 138, 252–256.

    Article  PubMed  Google Scholar 

  • Drimmer, E. J., Gitlin, M. J., & Gwirtsman, H. E. (1983). Desipramine and methylphenidate combination treatment for depression: Case report. American Journal of Psychiatry, 140, 241–242.

    PubMed  CAS  Google Scholar 

  • Emerson, T. R., Pare, C.M.B., Turner, P., & Hathaway, N. R. (1981). The use of a beta blocker (Acebutolol, “Sectral”) and a benzodiazepine (Diazepam) in the treatment of anxiety. Current Therapeutic Research, 29, 693–703.

    Google Scholar 

  • Fabre, L. F., & Napoliello, M. J. (1981). An open dose-finding study of melperone in nonpsychotic outpatients with anxiety. Current Therapeutic Research, 30, 427–433.

    Google Scholar 

  • Feighner, J. P. (1980). Pharmacology: New antidepressants. Psychiatric Annals, 10, 388–395.

    Google Scholar 

  • Feighner, J. P., Merideth, C. H., & Hendrickson, G. A. (1982). A double-blind comparison of buspirone and diazepam in outpatients with generalized anxiety disorder. Journal of Clinical Psychiatry, 43(12), (Sec. 2), 103–108.

    PubMed  CAS  Google Scholar 

  • Fontaine, R., Annable, L., Chouinard, G., & Ogilvie, R. I. (1983). Bromazepam and diazepam in generalized anxiety: A placebo-controlled study with measurement of drug plasma concentrations. Journal of Clinical Psychopharmacology, 3(2), 80–87.

    Article  PubMed  CAS  Google Scholar 

  • Friedmann, C. T. H., Davis, L. J., Ciccone, P. E., & Rubin, R. T. (1980). Phase II double-blind controlled study of a new anxiolytic, Fenobam (McN-3377) vs. placebo. Current Therapeutic Research, 27(2), 144–151.

    Google Scholar 

  • Garcia-Sevilla, J. A., Zis, A. P., Hollingsworth, P. J., Greden, J. F., & Smith, C. B. (1981). Platelet 2-adrenergic receptors in major depressive disorder — Binding of tritiated Clonidine before and after tricyclic antidepressant drug treatment. Archives of General Psychiatry, 38, 1327–1333.

    Article  PubMed  CAS  Google Scholar 

  • Gelenberg, A. J., Wojcik, J. D., Gibson, C. J., & Wurtman, R. J. (1982). Tyrosine for depression. Journal of Psychiatric Research, 17, 175–180.

    Article  PubMed  Google Scholar 

  • Gelenberg, A. J., Wojcik, J. D., Growdon, J. H., Sved, A. F., & Wurtman, R. J. (1980). Tyrosine for the treatment of depression. American Journal of Psychiatry, 137, 622–623.

    PubMed  CAS  Google Scholar 

  • Goldberg, H. L., & Finnerty, R. (1982). Comparison of buspirone in two separate studies. Journal of Clinical Psychiatry, 43(12) (Sec. 2), 87–91.

    PubMed  CAS  Google Scholar 

  • Goldberg, I. K. (1980). L-tyrosine in depression. The Lancet, 364.

    Google Scholar 

  • Goodwin, F. K., Prange, A. J., Jr., Post, R. M., Muscettola, G., & Lipton, M. A. (1982). Potentiation of antidepressant effects by L-triiodothyronine in tricyclic nonresponders. American Journal of Psychiatry, 139, 24–38.

    Google Scholar 

  • Greenblatt, D. J., Shader, R. I., Harmatz, J. S., Franke, K., & Koch-Weser, J. (1977). Absorption rate, blood concentrations, and early response to oral chlordiazepoxide. American Journal of Psychiatry, 134, 559–562.

    PubMed  CAS  Google Scholar 

  • Haefely, W., Pole, P., Pieri, L., Schaffner, R., & Laurent, J. P. (1983). Neuropharmacology of benzodiazepines: Synaptic mechanisms and neural basis of action. In E. Costa (Ed.), The benzodiazepines: From molecular biology to clinical practice. New York: Raven Press.

    Google Scholar 

  • Itoh, H., Takahashi, R., & Miura, S. (1980). Alprazolam, a new type anxiolytic in neuroleptic patients — — A pilot study. International Pharmacopsychiatry, 15, 344–349.

    PubMed  CAS  Google Scholar 

  • Janke, W., & Netter, P. (1983). Anxiolytic effects of drugs: Approaches, methods and problems. Neuropsychobiology, 9, 33–40.

    Article  PubMed  CAS  Google Scholar 

  • Jimerson, D. C., Post, R. M., Stoddard, F. J., Gillin, J. C., & Bunney, W. E. (1980). Preliminary trial of the noradrenergic agonist Clonidine in psychiatric patients. Biological Psychiatry, 15, 45–57.

    PubMed  CAS  Google Scholar 

  • Kaneko, M., Kumashiro, H., Takahashi, Y., & Hoshino, Y. (1979). L-5-HTP treatment and serum 5-HT level after L-5-HTP loading on depressed patients. Neuropsychobiology, 5, 232–240.

    Article  PubMed  CAS  Google Scholar 

  • Kathol, R. G., Noyes, R. Jr., Slymen, D. J., Crowe, R. R., Clancy, J., & Kerber, R. E. (1980). Propranolol in chronic anxiety disorders — A controlled study. Archives of General Psychiatry, 37, 1361–1365.

    Article  PubMed  CAS  Google Scholar 

  • Kelwala, S., Jones, D., & Sitaram, N. (1983). Monoamine metabolites as predictors of antidepressant response: A critique. Progress in Neuropsychopharmacology & Biological Psychiatry, 7, 229–240.

    Article  CAS  Google Scholar 

  • Klaiber, E. L., Broverman, D. M., Vogel, W., & Kobayashi, T. (1979). Estrogen therapy for severe persistent depression in women. Archives of General Psychiatry, 36, 550–554.

    Article  PubMed  CAS  Google Scholar 

  • Klein, D. F. (1964). Delineation of two drug responsive anxiety syndromes. Psychopharmacologia, 5, 397–408.

    Article  PubMed  CAS  Google Scholar 

  • Klein, D. F., Davis, J. M. (1969). Diagnosis and drug treatment of psychiatric disorders. Baltimore: Williams & Wilkins.

    Google Scholar 

  • Kolasa, K., Fusi, R., Garattini, S., Consolo, S., & Ladinsky, H. (1982). Neurochemical effects of buspirone, a novel psychotropic drug, on the central cholinergic system. Journal of Pharmacy and Pharmacology, 34, 314–317.

    Article  PubMed  CAS  Google Scholar 

  • Lader, M. (1979). Anxiety reduction and sedation: Psychophysiological theory. British Journal of Clinical Pharmacology, 7, 99S-105S.

    Google Scholar 

  • Lader, M., & Petursson, H. (1981). Benzodiazepine derivatives — Side effects and dangers. Biological Psychiatry, 16, 1195–1201.

    PubMed  CAS  Google Scholar 

  • Lader, M., & Petursson, H. (1983). Rational use of anxiolytic/sedative drugs. Drugs, 25, 514–528.

    Article  PubMed  CAS  Google Scholar 

  • Langer, G., Aschauer, H., Koinig, G., Resch, F., & Schonbeck, G. (1983). The TSH-response to TRH: A possible predictor of outcome to antidepressant and neuroleptic treatment. Progress in Neuropsychopharmacology & Biological Psychiatry, 7, 335–342.

    Article  CAS  Google Scholar 

  • Lapierre, Y. D. (1983). New antidepressant drugs. Journal of Clinical Psychiatry, 44, 41–44.

    PubMed  CAS  Google Scholar 

  • Lapierre, Y.D., & Oyewumi, L.K. (1982). Fenobam, another anxiolytic? Current Therapeutic Research, 31, 95–101.

    Google Scholar 

  • Leonard, B. E. (1980). Pharmacological properties of some “second generation” antidepressant drugs. Neuropharmacology, 19, 1175–1183.

    Article  PubMed  CAS  Google Scholar 

  • Lloyd, K. J., Farley, I. J., Deck, J. H. N., et al., (1974). Serotonin and 5-hydroxyindoleacetic acid in discrete areas of the brainstem of suicide victims and control patients. Advances in Biochemistry & Psychopharmacology, 11, 387–397.

    CAS  Google Scholar 

  • Maas, J. W. (1975). Biogenic amines and depression: Biochemical and pharmacological separation of two types of depression. Archives of General Psychiatry, 32, 1357–1361.

    Article  PubMed  CAS  Google Scholar 

  • Maas, J. W., Koslow, S. H., Katz, M. M., Bowden, C. L., Gibbons, R. L., Stokes, P. E., Robins, E., & Davis, J. M. (1984). Pretreatment neurotransmitter metabolite levels and response to tricyclic antidepressant drugs. American Journal of Psychiatry, 141, 1159–1171.

    PubMed  CAS  Google Scholar 

  • Mann, J., Peselow, E. D., Snyderman, S., & Gershon, S. (1980). D-phenyla-lanine in endogenous depression. American Journal of Psychiatry, 137, 1611–1612.

    PubMed  CAS  Google Scholar 

  • Meltzer, H. Y. (1983). The effect of buspirone on prolactin and growth hormone secretion in man. Archives of General Psychiatry, 40, 1099–1102.

    Article  PubMed  CAS  Google Scholar 

  • Mendels, J. (1976). Lithium in the treatment of depression. American Journal of Psychiatry, 133(4), 373–378.

    PubMed  CAS  Google Scholar 

  • Mohler, H., & Okada, T. (1977). Benzodiazepine receptor: Demonstration in the central nervous system. Science, 198, 849–851.

    Article  PubMed  CAS  Google Scholar 

  • Mohler, H., Pole, P., Sumin, R., Pieri, L., & Kettler, R. (1979). Nicotinamide is a brain constituent with benzodiazepine-like actions. Nature, 278, 563–565.

    Article  PubMed  CAS  Google Scholar 

  • Nies, A., Robinson, D. S., Bartlett, D., & Lambourn, M. R. (1977). M.A.O. inhibitors in clinical practice: Principles based on recent research. Psychopharmacological Bulletin, 13, 54–55.

    CAS  Google Scholar 

  • Oppenheim, G. (1983). Estrogen in the treatment of depression: Neuropharmacological mechanisms. Biological Psychiatry, 18, 721–725.

    PubMed  CAS  Google Scholar 

  • Pare, C. M. B. (1979). Monoamine oxidase inhibitors in resistant depression. International Psychopharmacopsychiatry, 14, 101–109.

    CAS  Google Scholar 

  • Pecknold, J. C., McClure, D. J., & Appeltauer, L. (1980). Fenobam in anxious out-patients. Current Therapeutic Research, 27, 119–123.

    Google Scholar 

  • Peet, M., & Coppen, A. (1980). Lithium treatment and prophylaxis in unipolar depression. Psychosomatics, 21, 303–313.

    PubMed  CAS  Google Scholar 

  • Prange, A. J., Wilson, I. C., Robon, A. M., & Lipton, M. (1969). Enhancement of imipramine antidepressant activity by thyroid hormone. American Journal of Psychiatry, 126, 457–469.

    PubMed  CAS  Google Scholar 

  • Quitkin, F. M., Rabkin, J. G., Ross, D., & McGrath, P. J. (1984). Duration of antidepressant drug treatment — What is an adequate trial? Archives of General Psychiatry, 41, 238–245.

    Article  PubMed  CAS  Google Scholar 

  • Ravaris, C. L., Robinson, D. S., Ives, J. O., Nies, A., & Bartlett, D. (1980). Phenelzine and amitriptyline in the treatment of depression — A comparison of present and past studies. Archives of General Psychiatry, 37, 1075–1080.

    Article  PubMed  CAS  Google Scholar 

  • Sachar, E. J., Hellman, L., & Fukushima, D. K. (1970). Cortisol production in depressive illness. A clinical and biochemical clarification. Archives of General Psychiatry, 23, 289–298.

    Article  PubMed  CAS  Google Scholar 

  • Schatzberg, A. F., Orsulak, P. J., Rosenbaum, A. H., Maruta, T., Kruger, E. R., Cole, J. O., & Schildkraut, J. J. (1982). Toward a biochemical classification of depressive disorders, V: Heterogeneity of unipolar depressions. American Journal of Psychiatry, 139, 471–475.

    PubMed  CAS  Google Scholar 

  • Schildkraut, J. J. (1965). The catecholamine hypothesis of affective disorders: A review of supporting evidence. American Journal of Psychiatry, 122, 509–522.

    PubMed  CAS  Google Scholar 

  • Seppala, T., Aranko, K., Mattila, M. J., & Shrotriya, R. C. (1982). Effects of alcohol on buspirone and lorazepam actions. Clinical Pharmacological Therapy, 32, 201–207.

    Article  CAS  Google Scholar 

  • Shader, R. I., & Greenblatt, P. J. (1977). Clinical implications of benzodiazepine pharmacokinetics. American Journal of Psychiatry, 134(6), 652–656.

    PubMed  CAS  Google Scholar 

  • Sheehan, D. V. (1984). Delineation of anxiety and phobic disorders responsive to monoamine inhibitors: Implications for classification. Journal of Clinical Psychiatry, 45 (Sec. 2), 29–36.

    PubMed  CAS  Google Scholar 

  • Sheehan, D. V., Ballenger, J., & Jacobsen, C. (1980). Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Archives of General Psychiatry, 37, 51–59.

    Article  PubMed  CAS  Google Scholar 

  • Sheehan, D. V., Coleman, J. H., Greenblatt, D. J., Jones, K. J., Levine, P. H., Orsulak, P. J., Peterson, M., Schildkrant, J. J., Uzogara, E., & Watkins, D. (1984). Biochemical correlates of panic attacks with agoraphobia and their response to a new treatment. Journal of Clinical Psychopharmacology, 4, 66–75.

    Article  PubMed  CAS  Google Scholar 

  • Sheehan, D. V., & Sheehan, K. H. (1982). The classification of anxiety and hysterical states. Part II. Toward a more heuristic classification. Journal of Clinical Psychopharmacology, 2, 386–393.

    PubMed  CAS  Google Scholar 

  • Shopsin, B., & Waters, B. (1980). The pharmacotherapy of major depressive syndrome. Part I: Treatment of acute depression. Psychosomatics, 21, 542–556.

    PubMed  CAS  Google Scholar 

  • Smith, C. B., Hollingsworth, P. J., Garcia-Sevilla, J. A., & Zis, A. P. (1983). Platelet alpha2 adrenoreceptors are decreased in number after antidepressant therapy. Progress in Neuropsycho-pharmacology & Biological Psychiatry, 7, 241–247.

    Article  CAS  Google Scholar 

  • Spitzer, R. L., & Williams, J. B. W. (1982). Hysteroid Dysphoria: An unsuccessful attempt to demonstrate its syndromal validity. American Journal of Psychiatry, 139(10), 1286–1291.

    PubMed  CAS  Google Scholar 

  • Sulser, F. (1983). Deamplification of noradrenergic signal transfer by antidepressants: A unified catecholamine-serotonin hypothesis of affective disorders. Psychopharmacological Bulletin, 19, 300–304.

    CAS  Google Scholar 

  • Targum, S. D. (1983). The application of serial neuroendocrine challenge studies in the management of depressive disorder. Biological Psychiatry, 18, 3–19.

    PubMed  CAS  Google Scholar 

  • Taylor, D. P., Riblet, L. A., Stanton, H. C., Eison, A. S., Eison, M. S., Temple, D. L. Jr. (1982). Dopamine and antianxiety activity. Pharmacological & Biochemical Behavior, 17, 25–35.

    Article  CAS  Google Scholar 

  • Tyrer, P. J., & Lader, M. H. (1974). Physiological response to propranolol and diazepam in chronic anxiety. British Journal of Clinical Pharmacology, 1, 387–390.

    Google Scholar 

  • Van Hiele, L. J. (1980). 5-hydroxytryptophan in depression: The first substitution therapy in psychiatry? Neuropsychobiology, 6, 230–240.

    Article  PubMed  Google Scholar 

  • Van Praag, H. M. (1980). Central monoamine metabolism in depressions. II. Catecholamines and related compounds. Comprehensive Psychiatry, 21, 44–54.

    Article  PubMed  Google Scholar 

  • Wharton, R. N., Perei, J. M., Dayton, P. G., & Malitz, S. (1971). A potential clinical use for methylphenidate (Ritalin) with tricyclic antidepressants. American Journal of Psychiatry, 127, 1619–1625.

    PubMed  CAS  Google Scholar 

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Lapierre, Y.D. (1986). New Approaches to the Pharmacological Treatment of Anxiety and Depression. In: Shaw, B.F., Segal, Z.V., Vallis, T.M., Cashman, F.E. (eds) Anxiety Disorders. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-5254-9_13

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