Garakani Amir, Murrough James W, Freire Rafael C, Thom Robyn P, Larkin Kaitlyn, Buono Frank D, Iosifescu Dan V
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Silver Hill Hospital, New Canaan, CT, United States.
Front Psychiatry. 2020 Dec 23;11:595584. doi: 10.3389/fpsyt.2020.595584. eCollection 2020.
Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.
焦虑症是最常见的精神疾病，也是导致残疾的主要原因。虽然创伤后应激障碍（PTSD）、抑郁症和精神分裂症的研究仍在不断扩展，但针对焦虑症进行研究的新型药物相对较少。本综述的首要目的是总结目前用于治疗惊恐障碍（PD）、广泛性焦虑症（GAD）、社交焦虑障碍（SAD）和特定恐惧症（SP）的药物治疗方法（包括已批准的和未标明的），包括选择性5-羟色胺再摄取抑制剂（SSRI）、5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）、阿扎哌隆类（如丁螺环酮）、混合性抗抑郁药（如米氮平）、抗精神病药、抗组胺药（如羟嗪）、α和β肾上腺素能药物（如普萘洛尔、可乐定）以及GABA能药物（苯二氮䓬类、普瑞巴林和加巴喷丁）。本综述不包括创伤后应激障碍和强迫症。其次，我们将综述正在研究的用于治疗成人焦虑症的新型药物治疗剂。所综述的途径和神经递质包括5-羟色胺能药物、谷氨酸调节剂、GABA能药物、神经肽、神经甾体、α和β肾上腺素能药物、大麻素和天然药物。综述结果显示，针对焦虑症缺乏随机双盲安慰剂对照试验，且很少有研究将新型治疗方法与现有的抗焦虑药物进行比较。尽管最近有一些针对新型药物的随机对照试验，包括主要针对广泛性焦虑症或社交焦虑障碍的神经肽、谷氨酸能药物（如氯胺酮和d-环丝氨酸）以及大麻素（包括大麻二酚），但这些试验大多为阴性，只有卡瓦和PH94B（一种吸入性神经甾体）有一些希望。总体而言，当前和未来焦虑症心理药理学研究的进展表明，需要进一步扩大对这些新型途径的研究，并对在小型试验中取得阳性结果的有前景的药物进行更大规模的研究。
