Subscribe to RSS
DOI: 10.1055/s-2005-922238
© Georg Thieme Verlag Stuttgart · New York
Trends in der Angsttherapie
Trends in the treatment of Anxiety DisordersPublication History
Publication Date:
22 November 2005 (online)
![](https://www.thieme-connect.de/media/psychoneuro/200510/lookinside/thumbnails/10.1055-s-2005-922238-1.jpg)
Zusammenfassung
Bei der Behandlung von Angststörungen wird heute eine Kombination von Pharmakotherapie und Kognitiver Verhaltenstherapie empfohlen. Neue Entwicklungen zielen auf schnellere, breitere Wirkung bei verbesserter Verträglichkeit, möglichst auch bei multimorbiden Patienten. Bei den Benzodiazepinen werden z.B. speichellösliche Darreichungsformen entwickelt. Neuentwicklungen bei den Antidepressiva sind z.B. das enatiomerenreine Escitalopram, retardiertes Paroxetin und der Serotonin- und Noradrenalin-Wiederaufnahmehemmer Duloxetin. Neue Behandlungsstrategien sind u.a. die Augmentation mit atypischen Antipsychotika. In der Pipeline stehen außerdem selektive Serotonin-Rezeptorliganden, neue GABA-A-Liganden, Antikonvulsiva, Neuropeptide, Neurosteroide und Modulatoren der neuroendokrinen Stressreaktion.
Summary
For the treatment of anxiety disorders, a combination of pharmacotherapy and cognitive-behavioural measures is recommended. New developments are aimed at achieving a more rapid and broader effect, together with improved tolerability, as far as possible also in multimorbid patients. Among the benzodiazepines, saliva.-soluble forms are being developed. New developments among the antidepressants, for example, include the pure S-enantiomer, escitalopram, slow-release paroxetine, and the serotonin and norepinephrine re-uptake inhibitor, duloxetine. New treatment strategies include augmentation with atypical antipsychotics. Furthermore, selective serotonin receptor ligands, new GABAA ligands, anticonvulsive drugs, neuropeptides, neurosteroids and modulators of the neuroendocrine stress reaction are all in the pipeline.
Literatur
- 1 Amital D, Fostick L, Sasson Y, Kindler S, Amital H, Zohar J. Anxiogenic effects of Sumatriptan in panic disorder: a double-blind, placebo controlled study. Eur Neropsychopharmacol. 2005; 15 279-283
- 2 Atack JR. Anxioselective compounds acting at the GABA(A) receptor benzodiazepine binding site. Curr Drug Targets CNS Neurol Disord. 2003; 2 213-232
- 3 Bandelow B, Zohar J, Hollander E. et al. . WFSBP Task force on treatment guidelines for the pharmacological treatment of anxiety-obsessive compulsive disorders and posttraumatic stress disorder. World J Biol Psychiatry. 2002; 3 171-199
- 4 Benjamin J, Levine J, Fux M, Aviv A, Levy D, Belmaker RH. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry. 1995; 152 1084-6
- 5 Chao IL. Olanzapin augmentation in panic disorder: a case report. Pharmacopsychiatry. 2004; 37 239-240
- 6 Crane DL. Ziprasidone as an augmenting agent in the treatment of anxiety-spectrum disorders. CNS Spectr. 2005; 10 176-179
- 7 Deren-Wesolek A, Tatarczynska E, Chojnacka-Wojcik E. The novel buspirone analogue, 8-(4-(2-(1,2,3,4-tetrahydroisoquinolinyl)(butyl)-8-azaspiro (4.5) decane-7,9-dione, with aniolytic-like and antidepressant-like effects in rats. J Psychopharmacol. 1998; 12 380-384
- 8 Halbreich U. Premenstrual dysphoric disorders: a diversified cluster of vulnerability traits to depression. Acta Psychiatr Scand. 1997; 95 169-176
- 9 Healy DG, Harkin A, Cryan JF. et al. . Metyrapone displays antidepressant-like properties in preclinical paradigms. Psychopharmacology. 1999; 145 303-308
- 10 Holsboer F. The rationale for corticotropin-releasing hormone receptor (CRH-R) antagonists to treat depression and anxiety. J Psychiatr Res. 1999; 33 181-214
- 11 Javitt DC. Glutamate as a therapeutic target in psychiatric disorders. Mol Psychiatry. 2004; 9 984-997
- 12 Keck ME, Holsboer F. Hyperactivity of CRH neuronal circuits as a target for therapeutic interventions in affective disorders. Peptides. 2001; 22 835-844
- 13 Keck ME, Welt T, Muller MB. et al. . The high-affinity non-peptide CRH1 receptor antagonist R121919 attenuates stressinduced alterations in plasma oxytocin, prolactin, and testosterone secretion in rats. Pharmacopsychiatry. 2003; 36 27-31
- 14 Klodzynska A, Tatarczynska E, Stachowicz K, Chojnacka-Wojcik E. The anxiolytic-like activity of AIDA (1-aminoindan-1,5-dicarboxolic acid), an mGlu 1 receptor antagonist. J Physiol Pharmacol. 2004; 55 113-126
- 15 Kramer MS, Cutler N, Feighner J. et al. . Distinct mechanism for antidepressant activity by blockade of central substance P receptors. Science. 1998; 281 1640-1645
- 16 Kronenberg G, Berger P, Tauber RF, Bandelow B, Henkel V, Heuser I. Randomized, double-blind study of SR142801 (Osanetant). A novel neurokinin-3 (NK3) receptor antagonist in panic disorder with pre- and posttreatment cholecystokinin tetrapeptide (CCK-4) challenges. Pharmacopsychiatry. 2005; 38 24-29
- 17 Kuhl H. Sexualhormone und Psyche. Stuttgart, New York: Thieme 2002
- 18 Lamberty Y, Falter U, Gower AJ, Klitgaard H. Anxiolytic profile of the antiepileptic drug levetiracetam in the Vogel conflict test in the rat. Eur J Pharmacol. 2003; 469 97-102
- 19 JM Le Melledo, G Baker. Role of progesterone and other neuroactive steroids in anxiety disorders. Expert Rev Neurother. 2004; 4 851-860
- 20 Liebsch F, Landgraf R, Engelmann M. et al. . Differential behavioural effects of chronic infusion of CRH1 and CRH2 receptor antisense oligonucleotides into the rat brain. J Psychiatry Res. 1999; 33 153-163
- 21 Majewska MD. Neurosteroids: endogenous bimodal modulators of the GABA-A receptor. Mechanisms of action and physiological significance. Prog Neurobiol. 1992; 38 379-395
- 22 Moroz G. High-potency benzodiazepines: recent clinical results. J Clin Psychiatry. 2004; 65 13-18
- 23 Murphy BE, Filipini D, Ghadirian AM. Possible use of glucocorticoid receptor antagonists in the treatment of major depression: preliminary results using RU 486. J Psychiatry Neurosci. 1993; 18 209-213
- 24 Nutt DJ, Forshall S, Bell C. et al. . Mechanisms of action of selective serotonin reuptake inhibitors in the treatment of psychiatric disorders. Eur Neuropsychopharmacol. 1999; 9 81-86
- 25 O'Dwyer AM, Lightman SL, Marks MN. et al. . Teatment of amjor depression with metyrapone and hydrocortisone. J Affect Disord. 1995; 33 123-128
- 26 Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001; 21 335-9
- 27 Pande AC, Pollack MH, Crockatt J. et al. . Placebo-controlled of gabapentin treatment of panic disorder. J Clin Psychopharmacol. 2000; 20 467-471
- 28 Pecknold JC, Luthe L, Scott MH Fleury. et al. . Gepirone and the treatment of panic disorder: an open study. J Clin Psychopharmacol. 1993; 13 145-149
- 29 Pelletier G, Steinbusch HW, Verhofstad AA. Immunoreactive substance P and serotonin present in the same dense-core vesicles. Nature. 1981; 293 71-72
- 30 Pigott TA. Gender differences in the epidemiology and treatment of anxiety disorders. J Clin Psychiatry. 1999; 60 4-15
- 31 Reddy DS. Pharmacology of endogenous neuroactive steroids. Crit. Rev. Neurobiol. 2003; 15 197-234
- 32 Rickels K. Alprazolam extended-release in panic disorder. Expert Opin Pharmacother. 2004; 5 1599-1611
- 33 Roy-Byrne PP. The GABA-benzodiazepine receptor complex: structure, function and role in anxiety. J Clin Psychiatry. 2005; 66 14-20
- 34 Sandford JJ, Forshall S, Bell C. et al. . Crossover trial of pagoclone and placebo in patients with DSM-IV panic disorder. J Psychopharmacol. 2001; 15 205-208
- 35 Sargent PA, Kjaer KH, Bench CJ. et al. . Brain serotonin1A receptor binding measured by positron emission tomography with (11C)WAY-100635: effects of depression and antidepresan treatment. Arch Gen Psychiatry. 2000; 57 174-180
- 36 Schoepp DD, Wright RA, Levine LR, Gaydos B, Potter WZ. LY354740, an mGlu2/3 receptor agonist as a novel approach to treat anxiety/stress. Stress. 2003; 6 189-197
- 37 Schweizer E. Generalized anxiety disorder. Longitudinal course and pharmacologic treatment. Psychiatr Clin North Am. 1995; 18 843-857
- 38 Serradeil-Le Gal C, Wagnon J 3rd, Tonnerre B, Roux R, Garcia G, Griebel G, Aulombard A. An overview of SSR149415, a selective nonpeptide vasopressin V (1b) receptor antagonist. CNS Drug Reviews. 2005; 11 53-68
- 39 Sheehan DV, Burnham DB, Iyengar MK, Perera P, Paxil CR. Panic Disorder Study Group . Efficacy and tolerability of controlled release paroxetine in the treatment of panic disorder. J Clin Psychiatry. 2005; 66 34-40
- 40 Ströhle A, Jahn H, Montkowski A. et al. . Central and peripheral administration of atriopeptin is anxiolytic in rats. Neuroendocrinology. 1997; 65 210-215
- 41 Simon NM, Worthington JJ, Doyle AC, Hoge EA, Kinrys G, Fischmann D, Link N, Pollack MH. An open-label study of levetiracetam for the treatment of social anxiety disorder. J Clin Psychiatry. 2004; 65 1219-1222
- 42 Spooren W, Gasparini F. mGlu5 receptor antagonists: a novel class of anxiolytics?. Drug News Perspect. 2004; 17 251-257
- 43 Ströhle A, Kellner M, Holsboer F. et al. . Anxiolytic activity of atrial natriuretic peptide in patients with panic disorder. Am J Psychiatry. 2001; 158 1514
- 44 Tatarczynska E, Klodzinska A, Stachowicz K, Chojnacka-Wojcik E. Effects of a selective 5-HT1b receptor agonist and antagonists in animal models of anxiety and depression. Behav Pharmacol. 2004; 15 523-534
- 45 Van Megen HJ, Westenberg HG, Den Boer JA. et al. . The cholecystokinin-B receptor antagonist CI-988 failed to affect CCK-4 induced symptoms in panic disorder patients. Psychopharmacology Berl. 11997; 29 243-248
- 46 EC Van Geffen, JG Hugtenburg, ER Heerdink, RP van Hulten, AC Egberts. Discontinuation symptoms in users of selective serotonin reuptake inhibitors in clinical practice: tapering versus abrupt discontinuation. Eur J Clin Pharmacol 2005
- 47 Van Vliet IM, Westenberg HG, Den Boer JA. Effects of the 5HT1A receptor agonist flesonoxan in panic disorder. Psychopharmacology Berl. 1996; 127 174-180
- 48 Vendruscolo LF, Takahashi RN, Bruske GR, Ramos A. Evaluation of the anxiolytic-like effect of NKP608, a NK1-receptor antagonist, in two rat strains that differ in anxiety-related behaviors. Psychopharmacology. 2003; 170 287-293
- 49 Versiani M, Cassano G, Perugi G, Benedetti A, Mastalli L, Nardi A, Savino M. Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder. J Clin Psychiatry. 2002; 63 31-7
- 50 Wedekind D, Bandelow B. Die Alpha-2-Delta Untereinheit des spannungsabhängigen Kalziumkanals. Ein neues pharmakologisches Ziel in der Psychiatrie und Neurologie. Nervenarzt
- 51 Wolkowitz OM, Reus VI, Chan T. et al. . Antiglucocorticoid treatment of depression: double-blindketokonazole. Biol Psychiatry. 1999; 45 1070-1074
- 52 Worthington JJ 3rd, Kinrys G, Wygant LE, Pollack MH. Aripiprazole as an augmentor of selective serotonin reuptake inhibitors in depression and anxiety disorder patients. Int Clin Psychopharmacol. 2005; 20 9-11
Korrespondenzadresse:
Dr. med. Dirk Wedekind
MScProf. Dr. med. Dipl.-Psych. Borwin Bandelow
Klinik für Psychiatrie und Psychotherapie der Georg-August-Universität Göttingen
Von-Siebold-Straße 5
37075 Göttingen
Email: dwedeki1@gwdg.de