Pharmacological treatment of anxiety disorders: Current treatments and future directions

Modern pharmacological treatments for anxiety disorders are safer and more tolerable than they were 30 years ago. Unfortunately, treatment efficacy and duration have not improved in most cases despite a greater understanding of the pathophysiology of anxiety. Moreover, innovative treatments have not reached the market despite billions of research dollars invested in drug development. In reviewing the literature on current treatments, we argue that evidence-based practice would benefit from better research on the causes of incomplete treatment response as well as the comparative efficacy of drug combinations and sequencing. We also survey two broad approaches to the development of innovative anxiety treatments:the continued development of drugs based on specific neuroreceptors and the pharmacological manipulation of fear-related memory. We highlight directions for future research, as neither of these approaches is ready for routine clinical use.

► Incomplete treatment response is common and should be studied using novel methods. ► Neurogenesis-promoting drugs appear promising but are in early development. ► Drugs that enhance memory consolidation may augment exposure-based therapy, but long-term data are needed. ► Adjunctive use of psychedelic and narcotic drugs with psychotherapy has poor empirical support.