Levetiracetam as adjunctive therapy for refractory anxiety disorders.

BACKGROUND: Anxiety disorders are the most prevalent psychiatric disorders as a group, and despite the effectiveness of currently available treatments for anxiety, many patients (40%-65%) remain symptomatic after initial intervention. Thus, there is a significant need for efficacious pharmacologic agents that are safe and well tolerated and lead patients to remission of symptoms. We present a retrospective analysis that assessed the efficacy and tolerability of adjunctive levetiracetam, a novel anticonvulsant agent, in the treatment of refractory anxiety. METHOD: Forty patients with DSM-IV anxiety disorders, who were deemed partial responders or nonresponders to anxiolytic therapy, received adjunctive levetiracetam in a naturalistic fashion during the time period from January 2004 through December 2004. We conducted a retrospective chart review. The primary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Clinical Global Impressions-Improvement (CGI-I) scale. Mean change from baseline to endpoint was assessed using 2-tailed paired t tests. RESULTS: Levetiracetam at a mean +/- SD dose of 1969 +/- 819 mg/day for a mean +/- SD time period of 9.3 +/- 5.1 weeks was generally well tolerated. Patients were markedly ill with a mean +/- SD baseline CGI-S score of 6.2 +/- 0.6. Patients improved significantly, with an endpoint CGI-S score of 4.2 +/- 1.8 (p < .001) and CGI-I score of 2.6 +/- 1.2. Adverse events were generally mild, and only 4 patients discontinued levetiracetam because of side effects. CONCLUSION: These preliminary data suggest that levetiracetam may be an effective adjunctive treatment for patients with anxiety disorders who remain symptomatic despite initial anxiolytic therapy.

Levetiracetam for treatment-refractory posttraumatic stress disorder.

OBJECTIVE: To assess the use of levetiracetam, a novel anticonvulsant agent, in the treatment of refractory posttraumatic stress disorder (PTSD). METHOD: Retrospective analysis was conducted of 23 patients with DSM-IV diagnosis of PTSD who, after being deemed partial or nonresponders to antidepressant therapy, received levetiracetam in a naturalistic fashion. The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). Secondary outcome measures included the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impressions-Severity of Illness scale (CGI-S), and Clinical Global Impressions-Improvement scale (CGI-I). RESULTS: Levetiracetam at a mean+/-SD dose of 1967+/-650 mg/day for 9.7+/-3.7 weeks was generally well tolerated. Nineteen patients (83%) were taking at least 1 concomitant medication. Patients were severely ill with a mean baseline PCL-C score of 67.2+/-9.4, CGI-S score of 6.0+/-0.7, and HAM-A score of 26.8+/-4.9. Patients improved significantly on all measures (p<.001). Thirteen patients (56%) met responder criteria at endpoint (PCL-C mean change=23.5, CGI-I score

[Anxiety disorders in women: does gender matter to treatment?]. / Transtornos de ansiedade em mulheres: gênero influencia o tratamento?

Women have a substantially higher risk of developing lifetime anxiety disorders compared with men. In addition, research evidence has generally observed an increased symptom severity, chronic course, and functional impairment in women with anxiety disorders in comparison to men. However, the reasons for the increased risk in developing an anxiety disorder in women are still unknown and have yet to be adequately investigated. Evidence from various studies has suggested that genetic factors and female reproductive hormones may play important roles in the expression of these gender differences. The significant differences in onset and course of illness observed in men and women diagnosed with anxiety disorders warrants investigations into the need of differential treatment; however, evidence of gender differences in treatment response to different anxiety disorders are varying and remain largely inconclusive. This article reviews the prevalence, epidemiology, and phenomenology of the major anxiety disorders in women, as well as the implications of such differences for treatment.

Anxiety disorders in women: does gender matter to treatment?

Mulheres apresentam um risco significativamente maior comparado com o dos homens para o desenvolvimento de transtornos de ansiedade ao longo da vida. Além disso, diversos estudos sugerem maior gravidade de sintomas, maior cronicidade e maior prejuízo funcional dos transtornos de ansiedade entre as mulheres. Apesar disso, os motivos que levam a este aumento de risco no sexo feminino são ainda desconhecidos e precisam ser adequadamente investigados. Vários estudos apresentam evidências de que, entre as prováveis causas dessa diferença entre os sexos, estão os fatores genéticos e a influência exercida pelos hormônios sexuais femininos. As diferenças de gênero encontradas nos transtornos de ansiedade em relação ao início e à evolução da doença indicam que é necessário investigar a necessidade de tratamentos diferenciados para homens e mulheres. Entretanto, as evidências de que as diferenças de gênero modifiquem a resposta ao tratamento dos transtornos ansiosos ainda são inconsistentes e amplamente inconclusivas. Este artigo procura rever a literatura existente a respeito da prevalência, epidemiologia e fenomenologia dos transtornos ansiosos entre as mulheres e as implicações destas peculiaridades para a melhor eficácia no seu tratamento.

Anticonvulsants in anxiety disorders.

Anticonvulsant drugs have shown promising results in the treatment of mood disorders, leading to the investigation of their potential efficacy in other psychiatric disorders. Numerous case reports, open-label trials, and placebo- controlled trials investigating the use of anticonvulsants in the treatment of anxiety disorders have yielded broad and varying results. Generally, these studies have indicated a potential role for anticonvulsants in the treatment of anxiety as monotherapy or augmentation therapy; however, these early findings must be supported by additional investigation in large-scale, placebo-controlled studies. This article reviews past and current research being done in this novel area of psychopharmacology.

Aripiprazole as an augmentor of selective serotonin reuptake inhibitors in depression and anxiety disorder patients.

More than half of anxiety and depression patients treated with an adequate course of antidepressants fail to fully improve. We retrospectively examined whether treatment-resistant depression and anxiety disorder patients responded to and tolerated augmentation with the atypical antipsychotic, aripiprazole. We report on patients with depression and anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety and post-traumatic stress disorder, who had an incomplete response to a variety of selective serotonin reuptake inhibitors (SSRIs) and who received augmentation with aripiprazole. The primary outcome measure was the Clinical Global Impression of Improvement (CGI-I). In the intent-to-treat analysis, the mean+/-SD CGI-S was 3.8+/-1.3 at endpoint. Fifty-nine percent of subjects received CGI-I ratings of 1 or 2, 'much improved' or 'very much improved,' in terms of their depression and anxiety symptoms at the end of 12 weeks. Several patients showed an early (weeks 1-5), as well as sustained, response to augmentation with doses of aripiprazole between 15 and 30 mg/day. The results suggest that aripiprazole may be effective as an augmentation for patients with persistent depressive and anxiety disorders despite initial SSRI treatment. Because this is a retrospective case review, further prospective studies are required to confirm these findings.