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Vernon M Neppe MD, PhD
To educate in the area of mixed anxiety and depression and to discuss the clinical implications with regard to management options and problems.
The current classification of anxiety of a separation of panic and generalized anxiety disorder has historical and epidemiologic limitations. We review alternative perspectives of anxiety viewed along the normal - abnormal continuum, as well as the frameworks of somatic and psychic anxiety. Similarly, subdivisions into adjustment disorder, anxiety states, mixed anxiety / depression and organic anxiety disorder lead to a more fruitful approach as to the patientās pharmacologic needs.
Depression co-exists with anxiety in about four-fifths of cases and one third of diagnosed anxiety has co-existent depression. This implies that there is a legitimate mixed anxiety depression condition.
Future innovative approaches to anxiety and depression paradoxically imply a re-evaluation of management over the last century to eliminate side-effects and develop customized treatment. Alcohol, bromides, barbiturates and meprobamate have all had their problems. The benzodiazepines, an apparent major advance, have turned out to have benefits with selected but limited indications for anxiety. This is so because of their significant problems.
Legitimate alternatives for anxiety such as antidepressant, beta-adrenergic blockers and azapirones are examined. Specialized groups such as addicts, medically ill and geriatric patients, have their own particular problems. Psychopharmacology is rapidly approaching the age of specialized receptorology and serotonin subtypes play a major role in management of both anxiety and depression. The advent of the azapirones has been a significant advance and may exemplify the neuromodulating roles played by varying doses of drug impinging on a specific receptor, in this instance serotonin 1A.
The development of the tricyclic antidepressants with newer heterocyclic compounds have major implications for the anxiety-depression spectrum. At times, the two conditions need to be appropriately balanced in the context of rational polypharmacy.
© Copyright 1997 Pacific Neuropsychiatric Institute.