Psychopharmacology of anxiety

The drug treatment of anxiety has in the past been a controversial topic in psychiatry, but a solid research evidence base has led to the development of agreed clinical guidelines, integrating both medication and psychological therapies, which have been accepted as good clinical practice. Prescribing decisions are made carefully in the context of a therapeutic relationship with the patient. Current treatments are mainly drugs that act via the monoaminergic (antidepressants, buspirone, antipsychotics) or amino acid (benzodiazepines, anticonvulsants) neurotransmitter systems. This contribution outlines the clinical use, advantages and important side effects of the major drug classes and suggests suitable drug treatments for each of the major anxiety disorders, and for depression with prominent anxiety symptoms. Likely future developments in the field are also considered.