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Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review

  • Anxiety Disorders (A Pelissolo, Section Editor)
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Abstract

Many aspects of long-term pharmacological treatments for anxiety disorders (AnxDs) are still debated. We undertook an updated systematic review of long-term pharmacological studies on panic disorder (PD), generalized anxiety disorder (GAD), and social anxiety disorder (SAD). Relevant studies dating from January 1, 2012 to August 31, 2015 were identified using the PubMed database and a review of bibliographies. Of 372 records identified in the search, five studies on PD and 15 on GAD were included in the review. No studies on SAD were found. Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy. Paroxetine, escitalopram, and clonazepam can be effective for long-term treatment of PD. However, further studies are needed to draw conclusions about the long-term benzodiazepine use in PD, particularly for the possible cognitive side-effects over time. Pregabalin and quetiapine can be effective for long-term treatment of GAD, while preliminary suggestions emerged for agomelatine and vortioxetine. We did not find any evidence for determining the optimal length and/or dosage of medications to minimize the relapse risk. Few investigations have attempted to identify potential predictors of long-term treatment response. Personalized treatments for AnxDs can be implemented using predictive tools to explore those factors affecting treatment response/tolerability heterogeneity, including neurobiological functions/clinical profiles, comorbidity, biomarkers, and genetic features, and to tailor medications according to each patient’s unique features.

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Acknowledgments

The authors thank Massimiliano Grassi, MSc, and Raffaele Balletta, MD, Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy, for their contribution to literature search. Mr. Grassi and Mr. Balletta have no conflicts of interest to declare.

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  1. Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, 22032, Albese con Cassano, Como, Italy

    Giampaolo Perna, Alessandra Alciati, Alice Riva, Wilma Micieli & Daniela Caldirola

  2. Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands

    Giampaolo Perna

  3. Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA

    Giampaolo Perna

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Correspondence to Giampaolo Perna.

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Perna, G., Alciati, A., Riva, A. et al. Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review. Curr Psychiatry Rep 18, 23 (2016). https://doi.org/10.1007/s11920-016-0668-3

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