RECENT ADVANCES IN THE PHARMACOLOGICAL MANAGEMENT OF ANXIETY: FROM TRADITIONAL MEDICATIONS TO NOVEL THERAPEUTIC AGENTS

Management of Anxiety from Traditional Medicine to Novel Therapeutic Agents

Authors

  • Sanjita Das Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Plot No. 2, Yamina Expressway, Greater Noida, Uttar Pradesh, 201310
  • Ashfaque U. Department of Pharmacy, SMAS, Galgotias University, Greater Noida
  • Niwas V. Department of Pharmacy, SMAS, Galgotias University, Greater Noida

DOI:

https://doi.org/10.55766/sujst7008

Keywords:

Anxiety Disorders, Benzodiazepine, Psychedelics, SNRIs, SSRIs

Abstract

Anxiety disorders are the most prevalent psychiatric disorders and the primary cause of disability. The initial objective of this review is to provide a comprehensive overview of the current pharmacological treatments (both approved and off-label), including selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and GABAergic medications (benzodiazepines, pregabalin, and gabapentin), which are widely regarded as first-line pharmacological treatments for anxiety disorders. Investigate potential pharmacotherapeutic medications that are currently under development for the treatment of anxiety disorders in adult patients. The neurotransmitters and pathways that have been examined include psychedelic substances that follow the serotonergic pathway, modulators of the GABAergic system, neuro-steroids, therapies based on cannabinoids, and natural medications. The safety and tolerability of contemporary pharmacological treatments for anxiety disorders have progressed significantly compared to three decades ago. In summary, the progress in Traditional Pharmacological Treatments and new Pharmacotherapies research in anxiety disorders suggests the need for further investigation of these innovative approaches and larger-scale investigations of potential candidates with positive results from smaller trials.

Author Biographies

Ashfaque U., Department of Pharmacy, SMAS, Galgotias University, Greater Noida

Research Scholar

Niwas V., Department of Pharmacy, SMAS, Galgotias University, Greater Noida

Research Scholar

References

Adams, L.M. and Geyer, M.A. (1985). Patterns of exploration in rats distinguish lisuride from lysergic acid diethylamide. Pharmacology Biochemistry and Behavior, 23(3):461-468. https://doi.org/10.1016/0091-3057(85)90022-X

Ahola, K., Virtanen, M., Honkonen, T., Isometsä, E., Aromaa, A., and Lönnqvist, J. (2011). Common mental disorders and subsequent work disability: A population-based health 2000 study. Journal of Affective Disorders, 134(1):365-372. https://doi.org/10.1016/j.jad.2011.05.028

Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J.M., Katz, S.J., Kessler, R.C., Kovess, V., Lépine, J.P., Ormel, J., Polidori, G., Russo, L.J., Vilagut, G., Almansa, J., Arbabzadeh-Bouchez, S., Autonell, J.. Bernal, M.. Buist-Bouwman, M.A., Codony, M., Domingo-Salvany, A., Ferrer, M., Joo, S.S., Martínez-Alonso, M., Matschinger, H., Mazzi, F., Morgan, Z., Morosini, P., Palacín, C., Romera, B., Taub, N., and Vollebergh, W.A.M. (2004). Disability and quality of life impact of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109(s420):38-46. https://doi.org/10.1111/j.1600-0047.2004.00329.x

Alonso, J., Liu, Z., Evans-Lacko, S., Sadikova, E., Sampson, N., Chatterji, S., Abdulmalik, J., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L.H., Bruffaerts, R., Cardoso, G., Cia, A., Florescu, S., de Girolamo, G., Gureje, O., Haro 18, J.M., He, Y., de Jonge, P., Karam, E.G., Kawakami, N., Kovess-Masfety, V., Lee, S., Levinson, D., Medina-Mora, M.E., Navarro-Mateu, F., Pennell, B.-E., Piazza, M., Posada-Villa, J., Have, M.T., Zarkov, Z., Kessler, R.C., Thornicroft, G., and WHO World Mental Health Survey Collaborators. (2018). Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depression and Anxiety, 35(3):195-208. https://doi.org/10.1002/da.22711

Bai, X., France, C.P., and Gerak, L.R. (2011). The discriminative stimulus effects of midazolam are resistant to modulation by morphine, amphetamine, dizocilpine, and γ-butyrolactone in rhesus monkeys. Psychopharmacology, 217(4):495-504. https://doi.org/10.1007/s00213-011-2302-8

Baldwin, D.S., Aitchison, K., Bateson, A., Curran, H.V., Davies, S., Leonard, B., Nutt, D.J., Stephens, D.N., and Wilson,

S. (2013). Benzodiazepines: risks and benefits. A reconsideration. Journal of Psychopharmacology, 27(11):967-971. https://doi.org/10.1177/0269881113503509

Baldwin, D.S., Anderson, I.M., Nutt, D.J., Bandelow, B., Bond, A., Davidson, J.R.T., den Boer, J.A., Fineberg, N.A., Knapp, M., Scott, J., and Wittchen, H.-U. (2005). Evidence-based guidelines for the pharmacological treatment of anxiety disorders: Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 19(6):567-596. https://doi.org/10.1177/0269881105059253

Bandelow, B. and Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3):327-335. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow

Bandelow, B., Andersen, H.F., and Dolberg, O.T. (2007). Escitalopram in the treatment of anxiety symptoms associated with depression. Depression and anxiety 24(1):53-61. https://doi.org/10.1002/da.20141

Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., and Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology, 30(4):183-192. https://doi.org/10.1097/YIC.0000000000000078

Belzung, C., ElHage, W., Moindrot, N., and Griebel, G. ( 2001). Behavioral and neurochemical changes following predatory stress in mice. Neuropharmacology, 41(3):400–408. https://doi.org/10.1016/S0028-3908(01)00072-7

Berg, K.A., Maayani, S., Goldfarb, J., Scaramellini, C., Leff, P., and Clarke, W.P. (1998). Effector pathway-dependent relative efficacy at serotonin type 2A and 2C receptors: Evidence for agonist-directed trafficking of receptor stimulus. Molecular Pharmacology, 54(1):94-104. https://doi.org/10.1124/mol.54.1.94

Biggio, G., Concas, A., Conda, M.G., Giorgi, O., Sanna, E., and Serra, M. (1990). GABAergic and dopaminergic transmission to the rat cerebral cortex: Effect of stress, anxiolytic and nanoscale drugs. Pharmacology and Therapeutics, 48(1):121-142. https://doi.org/10.1016/0163-7258(90)90074-C

Bremner, J.D., Randall, P., Scott, T.M., Bronen, R.A., Seibyl, J.P., Southwick, S.M., Delaney, R.C., McCarthy, G., Charney, D.S., and Innis, R.B. (1995). MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. American Journal of Psychiatry, 152(7):973-981. https://doi.org/10.1176/ajp.152.7.973

Carter, L.P., Griffiths, R.R., Suess, P.E., Casada, J.H., Wallace, C.L., and Roache, J.D. (2007). Relative abuse liability of indiplon and triazolam in humans: A comparison of psychomotor, subjective, and cognitive effects. Journal of Pharmacology and Experimental Therapeutics, 322(2):749-759. https://doi.org/10.1124/jpet.107.119693

Catterson, M.L. and Preskorn, S.H. (1996). Pharmacokinetics of selective serotonin reuptake inhibitors: clinical relevance. Pharmacology & Toxicology, 78(4):203-208. https://doi.org/10.1111/j.1600-0773.1996.tb00206.x

Chessick, C.A., Allen, M.H., Thase, M.E., da Cunha, A.A.B.C.B.M., Kapczinski, F., de Lima, M.S., and Souza, J.J.S.S.d.S. (2006). Azapirones for generalized anxiety disorder. Cochrane Database of Systematic Reviews, 2006(3):CD006115. https://doi.org/10.1002/14651858.CD006115

Cheung, M.-Y.C., Shahed, J., and Jankovic, J. (2007). Malignant Tourette syndrome. Movement Disorders , 22(12):1743-1750. https://doi.org/10.1002/mds.21599

Chu, A. and Wadhwa R. (2020). Selective Serotonin Reuptake Inhibitors. StatPearls Publishing; Treasure Island, FL, USA.

Copeland, W.E., Angold, A., Shanahan, L., and Costello, E.J. (2014). Longitudinal patterns of anxiety from childhood to adulthood: The Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry, 53(1):21-33. https://doi.org/10.1016/j.jaac.2013.09.017

Craske, M.G., Stein, M.B., Eley, T.C., Milad, M.R., Holmes, A., Rapee, R.M., Wittchen, H.-U. (2017). Anxiety disorders. Nature Reviews Disease Primers, 3:17024. https://doi.org/10.1038/nrdp.2017.24

Cuomo, A., Barillà, G., Cattolico, M., Pardossi, S., Mariantoni, E., Koukouna, D., Carmellini, P, and Fagiolini, A. (2024). Perspectives on the impact of vortioxetine on the treatment armamentarium of major depressive disorder. Expert Review of Neurotherapeutics, 24(5):465-476. https://doi.org/10.1080/14737175.2024.2333394

Davidson, J.R.T., Hughes, D.L., George, L.K., and Blazer, D.G. (1993). The epidemiology of social phobia: Findings from the Duke Epidemiological Catchment Area Study. Psychological Medicine, 23(3):709-718. https://doi.org/10.1017/S0033291700025484

Davis, L., Barlow, D.H., and Smith, L. (2010). Comorbidity and the treatment of principal anxiety disorders in a naturalistic sample. Behavior Therapy, 41(3):296-305. https://doi.org/10.1016/j.beth.2009.09.002

Dawson, L.A. and Watson, J.M. (2009). Vilazodone: A 5‐HT1A receptor agonist/serotonin transporter inhibitor for the treatment of affective disorders. CNS Neuroscience and Therapeutics, 15(2):107-117. https://doi.org/10.1111/j.1755-5949.2008.00067.x

Deardorff, W.J. and Grossberg, G.T. (2014). A review of the clinical efficacy, safety and tolerability of the antidepressants vilazodone, levomilnacipran and vortioxetine. Expert Opinion on Pharmacotherapy, 15(17):2525-2542. https://doi.org/10.1517/14656566.2014.960842

Dejean, C., Courtin, J., Rozeske, R.R., Bonnet, M.C., Dousset, V., Michelet, T., and Herry, C. (2015). Neuronal circuits for fear expression and recovery: Recent advances and potential therapeutic strategies. Biological Psychiatry, 78(5):298-306. https://doi.org/10.1016/j.biopsych.2015.03.017

DeVane, C.L. (1998). Differential pharmacology of newer antidepressants. Journal of Clinical Psychiatry, 59(Suppl 20):85-93.

DeVane, C.L., Chiao, E., Franklin, M., and Kruep, E.J. (2005). Anxiety disorders in the 21st century: Status, challenges, opportunities, and comorbidity with depression. American Journal of Managed Care, 12 (Suppl):S344-S353.

Dimopoulos, V.G., Robinson J.S., 3rd, and Fountas K.N. (2008). The pearls and pitfalls of skull trephination as described in the hippocratic treatise “On Head Wounds”. Journal of the History of the Neurosciences, 17(2):131-140. https://doi.org/10.1080/09647040701296770

Drost, R.M., Paulus, A.T., Ruwaard, D., and Evers, S.M. (2013). Inter-sectoral costs and benefits of mental health prevention: Towards a new classification scheme. Journal of Mental Health Policy and Economics, 16(4):179-186. https://pubmed.ncbi.nlm.nih.gov/24526586

Fagan, H.A. and Baldwin, D.S. (2023). Pharmacological treatment of generalised anxiety disorder: current practice and future directions. Expert Review of Neurotherapeutics, 23(6):535-548. https://doi.org/10.1080/14737175.2023.2211767

First, M.B. (2010). Clinical utility in the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Professional Psychology: Research and Practice, 41(6):465. https://doi.org/10.1037/a0021511

Flint, A.J. (2005). Generalised anxiety disorder in elderly patients: Epidemiology, diagnosis and treatment options. Drugs and Aging, 22(2):101-114. https://doi.org/10.2165/00002512-200522020-00002

Gale, C. and Oakley-Browne, M. (2000). Anxiety disorder. BMJ, 321(7270):1204-1207. https://doi.org/10.1136/bmj.321.7270.1204

Garakani, A., Murrough, J.W., Freire ,R.C., Thom, R.P., Larkin, K., Buono, F.D., Iosifescu, D.V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11:595584. https://doi.org/10.3389/fpsyt.2020.595584

Gilbody, S., Whitty, P., Grimshaw, J., and Thomas, R. (2003). Educational and organizational interventions to improve the management of depression in primary care: A systematic review. JAMA, 289(23):3145-3151. https://doi.org/10.1001/jama.289.23.3145

Gitlin, M. (2006). Treatment-resistant bipolar disorder. Molecular Psychiatry, 11(3):227-240. https://doi.org/ 10.1038/sj.mp.4001793

Glennon, R.A., Titeler, M., and Young, R. (1986). Structure-activity relationships and mechanism of action of hallucinogenic agents based on drug discrimination and radioligand binding studies. Psychopharmacology Bulletin, 22(3):953-958.

Goldstein, B.J. and Goodnick P.J. (1998). Selective serotonin reuptake inhibitors in the treatment of affective disorders, 3: tolerability, safety, and pharmacoeconomics. Journal of Psychopharmacology, 12(suppl B):S55-S87. https://doi.org/10.1177/0269881198012003041

Hendriks, S.M., Spijker, J., Licht, C.M.M., Beekman, A.T.F., and Penninx, B.W.J.H. (2013). Two-year course of anxiety disorders: Different across disorders or dimensions? Acta Psychiatrica Scandinavica, 128(3):212-221. https://doi.org/10.1111/acps.12080

Hirschfeld, R.M. (2001). The comorbidity of major depression and anxiety disorders: Recognition and management in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 3(6):244-254. https://doi.org/10.4088/PCC.v03n0609

Hoffman, J.L. (1949). Clinical observations concerning schizophrenic patients treated by prefrontal leukotomy. New England Journal of Medicine, 241(6):233-236. https://doi.org/10.1056/NEJM194908112410604

Hughes, Z.A., Starr, K.R., Scott, C.M., Newson, M.J., Sharp, T., Watson, J.M., Hagan, J.J., and Dawson, L.A. (2007). Simultaneous blockade of 5-HT1A/B receptors and 5-HT transporters results in acute increases in extracellular 5-HT in both rats and guinea pigs: In vivo characterization of the novel 5-HT1A/B receptor antagonist/5-HT transport inhibitor SB-649915-B. Psychopharmacology (Berl), 192(2):121-133. https://doi.org/10.1007/s00213-006-0691-x

James, A.C., James, G., Cowdrey, F.A., Soler, A., and Choke, A. (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2015(2):CD004690. https://doi.org/10.1002/14651858.CD004690.pub4

Julien, R.M. (2013). Pharmacological treatment of anxiety disorders across the lifespan. In: Stahl, S.M. and Moore, B.A. (Eds.), Anxiety disorders: A guide for integrating psychopharmacology and psychotherapy. Routledge/Taylor & Francis Group, p. 51-70.

Kelly, T.H., Delzer, T.A., Martin, C.A., Harrington, N.G., Hays, L.R., and Bardo, M.T. (2009). Performance and subjective effects of diazepam and d-amphetamine in high and low sensation seekers. Behavioural Pharmacology, 20(5-6):505-517. https://doi.org/10.1097/FBP.0b013e3283305e8d

Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K.R., and Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6):617-627. https://doi.org/10.1001/archpsyc.62.6.617

Kessler, R.C., DuPont, R.L., Berglund, P., and Wittchen, H.U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. American Journal of Psychiatry, 156(12):1915-1923. https://doi.org/10.1176/ajp.156.12.1915

Ketter, T.A., Post, R.M., and Theodore, W.H. (1999). Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology, 53(5 Suppl 2):S53-S67.

Lapidus, K.A.B., Kopell, B.H., Ben-Haim, S., Rezai, A.R., and Goodman, W.K. (2013). History of psychosurgery: a psychiatrist’s perspective. World Neurosurgery, 80(3):S27.e1-S27.e16. https://doi.org/10.1016/j.wneu.2013.02.053

Lawrence, D.K. and Gill, E.W. (1975). Structurally specific effects of some steroid anesthetics on spin-labeled liposomes. Molecular Pharmacology, 11(3):280-286. https://doi.org/10.1016/S0026-895X(25)10635-4

Lepola, U., Arato, M., Zhu, Y., and Austin, C. (2003). Sertraline versus imipramine treatment of comorbid panic disorder and major depressive disorder. Journal of Clinical Psychiatry, 64(6):654-662. https://doi.org/10.4088/jcp.v64n0606

Licata, S.C. and Rowlett, J.K. (2008). Abuse and dependence liability of benzodiazepine-type drugs: GABAA receptor modulation and beyond. Pharmacology Biochemistry and Behavior, 90(1):74-89. https://doi.org/10.1016/j.pbb.2008.01.001

Lile, J.A., Kelly, T.H., and Hays, L.R. (2010). The reinforcing, self-reported performance and physiological effects of Δ9-tetrahydrocannabinol, triazolam, hydromorphone, and methylphenidate in cannabis users. Behavioural Pharmacology, 21(1):29-38. https://doi.org/10.1097/FBP.0b013e32833470d7

López-Muñoz, F., Alamo, C., Cuenca, E., Shen, W.W., Clervoy, P., and Rubio, G. (2005). History of the discovery and clinical introduction of chlorpromazine. Annals of Clinical Psychiatry, 17(3):113-135. https://doi.org/10.1080/10401230591002002

Löw, K., Crestani, F., Keist, R., Benke, D., Brünig, I., Benson, J.A., Fritschy, J.-M., Rülicke, T., Bluethmann, H., Möhler, H., and Rudolph, U. (2000). Molecular and neuronal substrate for the selective attenuation of anxiety. Science, 290(5489):131-134. https://doi.org/10.1126/science.290.5489.131

Madaan, V. and Wilson, D.R. (2009). Neuropeptides: Relevance in treatment of depression and anxiety disorders. Drug News & Perspectives, 22(6):319-324. https://doi.org/10.1358/dnp.2009.22.6.1395255

Meier, S.M., Mattheisen, M., Mors, O., Mortensen, P.B., Laursen, T.M., and Penninx, B.W. (2016). Increased mortality among people with anxiety disorders: Total population study. British Journal of Psychiatry, 209(3):216-221. https://doi.org/10.1192/bjp.bp.115.171975

Meltzer-Brody, S. Colquhoun, H. Riesenberg, R. Epperson, C.N. Deligiannidis, K.M. Rubinow, D.R. Li, H. Sankoh, A.J. Clemson, C. Schacterle, A. Jonas, J. and Kanes, S. (2018). Brexanolone injection in postpartum depression: 2 multicenter, double-blind, randomized, placebo-controlled phase 3 trials. Obstetric Anesthesia Digest 39(2):87-88. https://doi.org/10.1016/S0140-6736(18)31551-4

Momen, N.C., Plana-Ripoll, O., Agerbo, E., Benros, M.E., Børglum, A.D., Christensen, M.K., Dalsgaard, S., Degenhardt, L., de Jonge, P., Debost, J.-C.P.G., Fenger-Grøn, M., Gunn, J.M., Iburg, K.M., Kessing, L.V., Kessler, R.C., Laursen, T.M., Lim, Carmen, C.W., Mors, O., Mortensen, P.B., Musliner, K.L., Nordentoft, M., Pedersen, C.B., Petersen, L.V., Ribe, A.R., Roest, A.M., Saha, S., Schork, A.J., Scott, K.M., Sievert, C., Sørensen, H.J., Stedman, T.J., Vestergaard, M., Vilhjalmsson, B., Werge, T., Weye, N., Whiteford, H.A., Prior, A,., and McGrath, J.J. (2020). Association between mental disorders and subsequent medical conditions. New England Journal of Medicine, 382(18):1721-1731. https://doi.org/10.1056/NEJMoa1915784

Mowla, A., Dastgheib, S.A., and Jahromi, L.R. (2016). Comparing the effects of sertraline with duloxetine for depression severity and symptoms: a double-blind, randomized controlled trialvolume. Clinical Drug Investigatio, 36:539-543. https://doi.org/10.1007/s40261-016-0399-6

Nelson, J.C. (1997). Safety and tolerability of the new antidepressants. Journal of Clinical Psychiatry, 58(Suppl 6):26-31.

Neumann, J., Hofmann, B., Dhein, S., and Gergs, U. (2023). Cardiac roles of serotonin (5-HT) and 5-HT-receptors in health and disease. International Journal of Molecular Sciences, 24(5):4765. https://doi.org/10.3390/ijms24054765

Nichols, D.E. (2018). Chemistry and structure-activity relationships of psychedelics. Current Topics in Behavioral Neurosciences, 1-43. https://doi.org/10.1007/7854_2017_475

Nutt, D. and Carhart-Harris, R. (2021). The current status of psychedelics in psychiatry. JAMA Psychiatry, 78(2):121-122. https://doi.org/10.1001/jamapsychiatry.2020.2171

Ohayon, M.M., Shapiro, C.M., and Kennedy, S.H. (2000). Differentiating DSM-IV anxiety and depressive disorders in the general population: Comorbidity and treatment consequences. Canadian Journal of Psychiatry, 45(2):166-172. https://doi.org/10.1177/070674370004500207

Ormel, J., Raven, D., van Oort, F., Hartman, C.A., Reijneveld, S.A., Veenstra, R., Vollebergh, W.A.M., Buitelaar, J., Verhulst, F.C., and Oldehinkel, A.J. (2015). Mental health in Dutch adolescents: A TRAILS report on prevalence, severity, age of onset, continuity, and comorbidity of DSM disorders. Psychological Medicine, 45(2):345-360. https://doi.org/10.1017/S0033291714001469

Papp, L.A. (2007). Pharmacological approach to the management of stress and anxiety disorders. In: Lehrer, P.M., Woolfolk, R.L., and Sime, W.E. (Eds.). Principles and Practice of Stress Management. 3rd ed. Guilford Press, NY, p. 579-612.

Patterson, B., Boyle, M.H., Kivlenieks, M., and Van Ameringen, M. (2016). The use of waitlists as control conditions in anxiety disorders research. Journal of Psychiatric Research, 83:112-120. https://doi.org/10.1016/j.jpsychires.2016.08.013

Pichierri, G., Coppe, A., Lorenzetti, S., Murer, K., and Bruin, E.L. (2012). The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study. Clinical Interventions in Aging, 10(7):178-184. https://doi.org/10.2147/CIA.S32558

Pollack, M.H., Matthews, J., and Scott, E.R. (1998). Gabapentin as a treatment for anxiety disorders. American Journal of Psychiatry, 155(7):992-993. https://doi.org/10.1176/ajp.155.7.992

Rao, N. (2007). The clinical pharmacokinetics of escitalopram. Clinical Pharmacokinetics, 46(4):281-290. https://doi.org/10.2165/00003088-200746040-00002

Ravindran, L.N. and Stein, M.B. (2009). Pharmacotherapy of PTSD: Premises, principles, and priorities. Brain Research, 1293:24-39. https://doi.org/10.1016/j.brainres.2009.03.039

Ray, T.S. (2010). Psychedelics and the human receptorome. PLoS One, 5(2):e9019. https://doi.org/10.1371/journal.pone.0009019

Rickli, A., Moning, O.D., Hoener, M.C., and Liechti, M.E. (2016). Receptor interaction profiles of novel psychoactive tryptamines compared with classic hallucinogens. European Neuropsychopharmacology, 26(8):1327-1337. https://doi.org/10.1016/j.euroneuro.2016.05.001

Robison, R.A., Taghva, A., Liu, C.Y., and Apuzzo, M.L.J. (2013). Surgery of the mind, mood, and conscious state: an idea in evolution. World Neurosurg. 80(3):S2-26. https://doi.org/10.1016/j.wneu.2013.08.002

Roesler, R. and Schröder, N. (2011). Cognitive enhancers: Focus on modulatory signaling influencing memory consolidation. Pharmacology Biochemistry and Behavior, 99(2):155-163. https://doi.org/10.1016/j.pbb.2010.12.028

Roest, A.M., de Vries, Y.A., Lim, C.C.W., Wittchen, H.-U., Stein, D.J., Adamowski, T., Al-Hamzawi, A., Bromet, E.J., Viana, M.C., de Girolamo, G., Demyttenaere, K., Florescu, S., Gureje, O., Haro, J.M., Hu, C., Karam, E.G., Caldas-de-Almeida, J.M., Kawakami, N., Lépine, J.P., Levinson, D., Medina-Mora, M.E., Navarro-Mateu, F., 'Neill, S., Piazza, O., Posada-Villa, J.A., Slade, T., Torres, Y., Kessler, R.C., Scott, K.M., de Jonge, P., and WHO World Mental Health Survey Collaborators. (2019). A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys. Depression and Anxiety, 36(5):499-510. https://doi.org/10.1002/da.22885

Rossi, A., Barraco, A., and Donda, P. (2004). Fluoxetine: A review on evidence based medicine. Annals of General Psychiatry, 3(2). https://doi.org/10.1186/1475-2832-3-2

Rudolph, U. and Knoflach, F. (2011). Beyond classical benzodiazepines: novel therapeutic potential of GABAA receptor subtypes. Nature reviews Drug discovery 10.9 685-697. https://doi.org/10.1038/nrd3502

Ruscio, A.M., Hallion, L.S., Lim, C.C.W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L.H., Borges, G., Bromet, E.J., Bunting, B., Caldas de Almeida, J.M., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., Haro, J.M., He, Y., Hinkov, H., Hu, C., de Jonge, P., Karam, E.G., Lee, S., Lepine, J.-P., Levinson, D., Mneimneh, Z., Navarro-Mateu, F., Posada-Villa, J., Slade, T., Stein, D.J., Torres, Y., Uda, H., Wojtyniak, B., Kessler, R.C., Chatterji, S., and Scott, K.M. (2017). Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry, 74(5):465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056

Rush, A.J., Trivedi, M.H., Wisniewski, S.R., Nierenberg, A.A., Stewart, J.W., Warden, D., Niederehe, G., Thase, M.E., Lavori, P.W., Lebowitz, B.D., McGrath, P.J., Rosenbaum, J.F., Sackeim, H.A., Kupfer, D.J., Luther, J., and Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR D report. American Journal of Psychiatry, 163(11):1905-1917. https://doi.org/10.1176/appi.ajp.163.11.1905

Sanchez, C., Asin, K. E., and Artigas, F. (2015). Vortioxetine, a novel antidepressant with multimodal activity: Review of preclinical and clinical data. Pharmacology and Therapeutics, 145:43-57. https://doi.org/10.1016/j.pharmthera.2014.07.001

Sartorius, N., Ustun, T.B., Lecrubier, Y., and Wittchen, H.U. (1996). Depression comorbid with anxiety: Results from the WHO study on psychological disorders in primary health care. British Journal of Psychiatry Supplement, 168(S30):38-43. https://doi.org/10.1192/S0007125000298395

Scoville, W.B. (1949). Selective cortical undercutting as a means of modifying and studying frontal lobe function in man: Preliminary report of forty-three operative cases. Journal of Neurosurgery, 6(1):65-73. https://doi.org/10.3171/jns.1949.6.1.0065

Selye, H. (1942). Correlations between the chemical structure and the pharmacological actions of the steroids. Endocrinology, 30(3):437-453. https://doi.org/10.1210/endo-30-3-437

Silove, D.M., Tay, A.K., Tol, W.A., Tam, N., dos Reis, N., da Costa, Z., Soares, C., and Rees, S. (2016). Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence. Journal of Affective Disorders, 205:292-300. https://doi.org/10.1016/j.jad.2016.07.052

Simpson, G. (2007). Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management. Brain Injury, 21(13-14):1335-1351.

Sinclair, L.I., Christmas, D.M., Hood, S.D., Potokar, J.P., Robertson, A., Isaac, A., Srivastava, S., Nutt, D.J., and Davies, S.J.C., (2009). Antidepressant-induced jitteriness/anxiety syndrome: Systematic review. British Journal of Psychiatry, 194(6):483-490. https://doi.org/10.1192/bjp.bp.107.048371

Stahl, S.M. (2005). Essential psychopharmacology: The prescriber’s guide. Cambridge University Press, NY, US.

Stein, D.J., Lim, C.C.W., Roest, A.M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E.J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J.M., Harris, M.G., He, Y., Hinkov, H., Horiguchi, I., Hu, C., Karam, A., Karam, E.G., Lee, S., Lepine, J.-P., Navarro-Mateu, F., Pennell, B.-E., Piazza, M., Posada-Villa, J., ten Have, M., Torres, Y., Viana, M. C., Wojtyniak, B., Xavier, M., Kessler, R.C., Scott, K.M., and WHO World Mental Health Survey Collaborators. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15:143. https://doi.org/10.1186/s12916-017-0889-2

Stone, J.L. and Miles, M.L. (1990). Skull trepanation among the early Indians of Canada and the United States. Neurosurgery, 26(6):1015-1020. https://doi.org/10.1227/00006123-199006000-00016

Szabo, S.T. (2001). Interactions between serotonergic and noradrenergic systems: Their involvement in antidepressant treatment of anxiety and affective disorders, [Thesis]. McGill University Theses, 512p.

Trivedi, J.K. (2004). Terrorism and mental health. Indian Journal of Psychiatry, 46(1):7-14.

Victorri-Vigneau, C., Gérardin, M., Rousselet, M., Guerlais, M., Grall-Bronnec, M., and Jolliet, P. (2014). An update on zolpidem abuse and dependence. Journal of Addictive Diseases, 33(1):15-23. https://doi.org/10.1080/10550887.2014.882725

Viveros, M.P., Marco, E.M., and File, S.E. (2005). Endocannabinoid system and stress and anxiety responses. Pharmacology Biochemistry and Behavior, 81(2):331-342. https://doi.org/10.1016/j.pbb.2005.01.029

Wang, P.S., Berglund, P., and Kessler, R.C. (2000). Recent care of common mental disorders in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15(5):284-292. https://doi.org/10.1046/j.1525-1497.2000.9908044.x

Wang, S.M., Han, C., Lee, S.J., Patkar, A.A., Masand, P.S., and Pae, C.U. (2013). A review of current evidence for vilazodone in major depressive disorder. International Journal of Psychiatry in Clinical Practice, 17(3):160-169. https://doi.org/10.3109/13651501.2013.794245

Wang, Y.P., Chiavegatto Filho, A.D., Campanha, A.M., Malik, A.M., Mogadouro, M.A., Cambraia, M., and Viana, M.C., and Andrade, L.H. (2017). Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil. Epidemiology and Psychiatric Sciences, 26(1):89-101. https://doi.org/10.1017/S2045796016000202

Wardenaar, K.J., Lim, C.C.W., Al-Hamzawi, A.O., Alonso, J., Andrade, L.H., Benjet, C., Bunting, B., de Girolamo, G., Demyttenaere, K., Florescu, S.E., Gureje, O., Hisateru, T., Hu, C., Huang, Y., Karam, E., Kiejna, A., Lepine, J.P., Navarro-Mateu, F., Oakley Browne, M., Piazza, M., Posada-Villa, J., ten Have, M.L., Torres, Y., Xavier, M., Zarkov, Z., Kessler, R.C., Scott, K.M., and de Jonge, P. (2017). The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychological Medicine, 47(10):1744–1760. https://doi.org/10.1017/S0033291717000174

Wick, J. (2013). The history of benzodiazepines. Consultant Pharmacist, 28(9):538-548. https://doi.org/10.4140/TCP.n.2013.538

Wittchen, H.U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., Olesen, J., Allgulander, C., Alonso, J., Faravelli, C., Fratiglioni, L., Jennum, P., Lieb, R., Maercker, A., van Os, J., Preisig, M., Salvador-Carulla, L., Simon, R., and Steinhausen, H.-C. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(9):655-679. https://doi.org/10.1016/j.euroneuro.2011.07.018

Woods, S.W., Charney, D.S., Silver, J.M., Krystal, J.H., and Heninger, G.R. (1991). Behavioral, biochemical, and cardiovascular responses to the benzodiazepine receptor antagonist flumazenil in panic disorder. Psychiatry Research, 36(2):115-127. https://doi.org/10.1016/0165-1781(91)90124-8

World Health Organization. (2017). Depression and other common mental disorders: Global health estimates.

Xue, W., Wang, P., Li, B., Li, Y., Xu, X., Yang, F., Yao, X., Chen, Y.Z., Xu, F., and Zhu, F. (2015). Identification of the inhibitory mechanism of FDA approved selective serotonin reuptake inhibitors: An insight from molecular dynamics simulation study. Physical Chemistry Chemical Physics, 18(4):3260-3271. https://doi.org/10.1039/C5CP05771J

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2025-10-02

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Das, S., Ashfaque, U., & Niwas, V. (2025). RECENT ADVANCES IN THE PHARMACOLOGICAL MANAGEMENT OF ANXIETY: FROM TRADITIONAL MEDICATIONS TO NOVEL THERAPEUTIC AGENTS: Management of Anxiety from Traditional Medicine to Novel Therapeutic Agents. Suranaree Journal of Science and Technology, 32(4), 070084(1–18). https://doi.org/10.55766/sujst7008