Is pregabalin effective for generalized anxiety disorder (GAD)?
The findings of randomized controlled trials and meta-analyses together indicate that pregabalin is efficacious in both acute treatment and relapse prevention in GAD, with some evidence of an early onset of effect, and broad efficacy in reducing the severity of psychological and physical symptoms of anxiety.
What is the mechanism of action of pregabalin?
Pregabalin's mechanism of action (MOA; reducing neuronal excitability) stands in contrast to the MOA of benzodiazepines, which act by enhancing inhibitory activity in the GABAergic receptor complex, the most widely distributed fast inhibitory neurotransmitter in the central nervous system (Kent et al. 2002 ).
How does pregabalin affect psychic and somatic scores?
All active treatment groups showed a significant decline in the psychic subscore compared to placebo, but only pregabalin 200 mg bid showed a significant reduction in somatic subscore compared to placebo.44
Is pregabalin an atypic anxiolytic?
Our investigation showed that pregabalin, an atypic anxiolytic is efficient and well tolerable in trea … Efficacy and tolerability of pregabalin were high. Compared to sertraline, pregabalin showed more rapid onset of action and equal efficacy. Adverse reactions are short-lasting and the dose depends.
What does pregabalin do for anxiety?
Pregabalin is related to the calming brain chemical gamma aminobutyric acid (GABA). It reduces the release of brain chemicals that have a stimulating effect. It can take a little time for pregabalin to start helping with anxiety.
What is the best psychological model for treatment for GAD?
Cognitive behavioral therapy (CBT) for anxiety. Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.
What causes treatment resistant anxiety?
“The two biggest risk factors for treatment resistance are inadequate treatment and failure of patients to comply with treatment. The other important risk factor is having a comorbid condition, such as depression, bipolar disorder, or substance abuse,” says Bystritsky.
How do you treat physical symptoms of GAD?
Self-Care For Anxiety:Be physically active, if you're able. Exercise can help reduce stress and improve physical health. ... Avoid alcohol, caffeine, and nicotine. Any of these can make anxiety worse.Try relaxation techniques. ... Prioritize sleep.
What is first line treatment for generalized anxiety disorder?
Selective serotonin reuptake inhibitors (SSRIs) are generally considered first-line therapy for GAD and PD. Tricyclic antidepressants (TCAs) are better studied for PD, but are thought to be effective for both GAD and PD.
What is cognitive behavioral therapy for GAD?
CBT as treatment for GAD includes the development of a functional analysis, providing information through psychoeducation, experimentation with new behaviors and emotions (exposition, relaxation), and a cognitive approach.
What causes treatment-resistant?
There's no one reason for treatment-resistant depression. For most people, it's probably a mix of different factors. Some of them are beyond your control, such as the genes you were born with. Some things you can control.
Why is GAD difficult to treat?
A major limitation in the conceptualization of difficult-to-treat GAD is the lack of high-quality data regarding longer-term course of illness after initial nonresponse.
What is treatment-resistant anxiety?
Treatment-resistant (or refractory) GAD is defined as failure to respond to at least 1 trial of antidepressant therapy at adequate dose and duration.
What are the physical symptoms?
What are Somatic Symptoms and Related Disorders?body pains including headaches, joint pains.stomach aches, nausea, vomiting.fatigue, dizziness, memory problems.weakness, numbness.trouble breathing, shortness of breath.changes in vision or hearing including sudden blindness.a "stuck" feeling or a "lump" in the throat.More items...
What causes physical symptoms of anxiety?
If you have anxiety, your fear and worry trigger the fight-or-flight response, activating your sympathetic nervous system, which controls involuntary breathing and heart rate. This activation leads the body to release stress hormones such as adrenaline and cortisol, contributing to anxiety's physical symptoms.
What are the somatic symptoms of GAD?
1 DSM-IV lists 6 somatic symptoms associated with GAD: restlessness, increased fatigability, difficulty in concentrating, irritability, muscle tension, and sleep disturbance.
Is pregabalin safe to take?
Treatment with pregabalin is generally well tolerated; the drug has an adverse event profile that includes dizziness, somnolence and weight gain. The potential for abuse of pregabalin is low; the risk of withdrawal symptoms is generally low when the drug is discontinued gradually (over 1 week).
Is pregabalin an anxiolytic?
Pregabalin (Lyrica (®)), a well established anxiolytic agent, has been approved in the EU for the treatment of generalized anxiety disorder (GAD) in adults. It has a distinct mechanism of action relative to other anti-anxiety agents (α2δ binding at presynaptic voltage dependent calcium channels leading to inhibition of excitatory ...
Is there a definitive head to head study of pregabalin and SSRI?
It should be stressed, however, that definitive head-to-head studies comparing pregabalin with SSRI/SNRIs, including in patients with GAD and co-morbid major depressive disorder, are currently lacking.
Does pregabalin help with anxiety?
In long-term studies, pregabalin maintained improvements in anxiety symptoms that occurred in response to short-term treatment and delayed the time to relapse of GAD compared with placebo.
What are the items on the Hama subscale?
The HAMA psychic subscale items (items 1–6 and 14) consist of the following items: (1) anxious mood (worries, anticipation of the worst, fearful anticipation, irritability); (2) tension (feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax); (3) fears (of dark, of strangers, of being left alone, of animals, of traffic, of crowds); (4) insomnia (difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors); (5) intellectual (difficulty in concentration, poor memory); (6) depressed mood (loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing); and (14) behaviour at interview (fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc). The somatic subscale items (items 7–13) consist of the following items: (7) somatic muscular (pains and aches, twitchings, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone); (8) somatic sensory (tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation); (9) cardiovascular (tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, sighing, dyspnoea); (10) respiratory (pressure or constriction in chest, choking feelings, sighing, dyspnoea); (11) gastrointestinal (difficulty in swallowing, wind, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation); (12) genitourinary (frequency of micturition, urgency of micturition, amenorrhoea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence); and (13) autonomic symptoms (dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair).
Do benzodiazepines help with anxiety?
Benzodiazepines facilitate inhibitory GABAergic transmission , and have been reported to have relatively greater efficacy in treating somatic anxiety symptoms compared to psychic symptoms (Rickels et al. 1988, 1993 ).
What disorders were excluded from the axis I?
Patients were excluded if they suffered from any axis I disorder except dysthymia, simple phobia, social phobia, somatization disorder, or a history of major depressive disorder. Also, patients at suicide risk, as judged by the clinician on the basis of history or current severity of suicidal ideation, were excluded.
Is pregabalin an anxiolytic?
One novel agent, pregabalin, a structural analogue of γ-aminobutyric acid (GABA), is currently in development as an anxiolytic on the basis of its profile of pharmacologic activity in animal behavioral models such as the Vogel conflict test (9), commonly used to screen for antianxiety drugs.
Does pregabalin have withdrawal symptoms?
In short-term treatment, pregabalin does not appear to have the withdrawal symptoms associated with the benzodiazepines. Until recently, pharmacologic treatment of generalized anxiety disorder consisted of the benzodiazepines, buspirone, and monoamine reuptake inhibitor antidepressants.
Is pregabalin safe for withdrawal?
There were no serious adverse events reported by patients given pregabalin, and no withdrawal syndrome was associated with pregabalin treatment. CONCLUSIONS: These results indicate that pregabalin is an effective, rapidly acting, and safe treatment for generalized anxiety disorder.
Is pregabalin more effective than placebo?
Discussion. This study demonstrates that pregabalin is more effective than placebo in reducing the symptoms of anxiety as measured by the Hamilton anxiety scale among patients with generalized anxiety disorder. The antianxiety effect of pregabalin was detectable as early as 1 week after initiation of treatment.
Does pregabalin have a receptor?
Despite its name, pregabalin has no clinically relevant binding to any γ-aminobutyric acid (GABA) type A or type B receptors or transporters (Li et al. 2011 ). Instead, pregabalin exhibits high affinity binding to the α2δ type 1 protein of a neuronal voltage-gated calcium channel. Pregabalin binding reduces the intracellular availability of calcium that is required for membrane fusion and release of neurotransmitter into the synaptic cleft, thus resulting in significant inhibition of the release of neurotransmitters implicated in pathological anxiety, such as glutamate and monoamine neurotransmitters (Coderre et al. 2005; Cunningham et al. 2004; Dooley et al. 2000 a, b; Li et al. 2011; Maneuf et al. 2001; Maneuf & McKnight, 2001 ).
Is pregabalin a symptom of GAD?
Insomnia is a common component of the clinical presentation of GAD and pregabalin appears to be an efficacious treatment for this often chronic and disabling symptom. Anxiety, insomnia, pregabalin, sleep disturbance.
Is pregabalin good for insomnia?
Pregabalin belongs to a relatively new class of anxiolytics whose MOA, reducing neuronal excitability, stands in contrast to the anxiolytic mechanism of benzodiazepines, which target inhibitory activity in the benzodiazepine-GABAergic receptor complex. As this review has shown, treatment with pregabalin is associated with improvement in early, middle and late forms of insomnia, with improvement in sleep among patients with GAD resulting in reduction in functional impairment and improvement in quality of life. Overall, treatment with pregabalin is well tolerated and many of the most common adverse events are mild to moderate in intensity and limited to the first 2–3 wk treatment. Although sedation may occur as an adverse event in some patients, the incidence is lower compared to benzodiazepines. Pregabalin is a valuable treatment option for patients with GAD who present with insomnia.
What to ask a psychiatrist about depression?
Consider your response to treatment, including medications, psychotherapy or other treatments you've tried.
What type of therapy is used to help with depression?
Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression. Family or marital therapy. This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression.
What is the best treatment for depression?
Psychological counseling. Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression.
What is the treatment for GAD?
Treatment of GAD and other anxiety disorders in children and adults frequently consists of both psychotherapy and pharmacotherapy. In fact, numerous studies suggest concurrent psychotherapy amplifies the benefits of pharmacotherapy (e.g., sertraline, fluoxetine, etc.) [12–15].
What is a GAD?
Generalized anxiety disorder (GAD), a chronic illness, often begins during adolescence or early adulthood and persists throughout the lifespan. Randomized controlled trials support the efficacy of selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), as well as benzodiazepines, azapirones, ...
Is aripiprazole good for CGI?
Two open-label studies of low-dose aripiprazole in adults with treatment-resistant GAD suggest that adjunctive aripiprazole is associated with significant improvement in terms of CGI and is generally well-tolerated, although a minority of patients discontinued treatment due to side effects [104,105].
Introduction
- Generalized anxiety disorder (GAD) has received increasing attention in recent years as a prevalent disorder associated with significant impairment. The National Comorbidity Survey – Replication study reported a lifetime prevalence rate of 5.7% for GAD (Kessler et al.2005). In primary-care settings, a 4% point prevalence of GAD has been reported, with >20% of patients di…
Methods
- Study design
All six randomized, double-blind, placebo-controlled studies of PGB in the treatment of GAD were pooled for this analysis. All trials were either 4 wk or 6 wk in duration, and all were fixed-dose studies (Table 1). In three of the studies, patients were randomized to receive either fixed doses … - Patient selection
Male and female patients enrolled in the six studies were aged at least 18 yr and met DSM-IV criteria for a primary diagnosis of GAD (APA, 1994). Patients were required to have a baseline HAMA total score ⩾20, a Covi Anxiety Scale (Lipman & Covi, 1976) score ⩾9, and a Raskin Depre…
Results
- Patient disposition
Across the six studies, a total of 1854 patients were randomized and received study medication; 1071 received PGB (excluding the 200-mg group utilized in one study), 299 received a high potency benzodiazepine (lorazepam, 69%; alprazolam, 31%), and 484 received placebo. Overall, … - Baseline characteristics of patients
Baseline demographic and clinical characteristics were similar for each treatment group (Table 3). Overall, ∼57% (±5%) of the sample were female, with an average age between 35 yr and 45 yr. Additional information on sample characteristics and patient disposition are available in the pri…
Discussion
- In this pooled analysis of six double-blind, short-term, fixed-dose GAD trials, treatment with PGB, in the 300–600 mg dosage range, significantly improved both the HAMA psychic and somatic anxiety symptom factors. In contrast, treatment with 150 mg/d PGB appeared to be less effective, achieving significance only on the psychic anxiety factor. Short...
Acknowledgements
- The authors acknowledge Mark Pollack, M.D., and Naomi Simon, M.D., for significant contributions to the initial draft of the manuscript; Francine S. Mandel, Ph.D., of Pfizer Inc., for assistance with statistical analyses, and Edward Schweizer, M.D., an employee of Paladin Consulting Group, Inc., for providing editorial assistance in the preparation of the manuscript wh…
Statement of Interest
- The clinical trials included in this report were sponsored by Pfizer Inc. Dr Lydiard has received grant/research support from Pfizer Inc, Sanofi-Aventis, Eli Lilly & Company, Cephalon, UCB Pharma, Neurocrine, AstraZeneca, Jazz Pharmaceuticals, Medicinova, Wyeth Pharmaceuticals, Bristol–Myers Squibb, Forest Research Labs, and Abbott and has served as a consultant for Eli L…