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Biomedical subjects

J R Davidson

Publications and source records attributed to J R Davidson.

At least 73 records · Page 4Linked to original sources
PubMed1999

Efficacy, safety, and tolerability of venlafaxine extended release and buspirone in outpatients with generalized anxiety disorder.

BACKGROUND: The objective of this randomized, double-blind study was to compare the efficacy and safety of venlafaxine extended release (XR) and buspirone in outpatients with generalized anxiety disorder (GAD) but without concomitant major depressive disorder. METHOD: Male and female outpatients at least 18 years old who met the DSM-IV criteria for GAD and had scores of 18 or higher on the Hamilton Rating Scale for Anxiety (HAM-A) were randomly assigned to treatment with either venlafaxine XR (75 or 150 mg/day), buspirone (30 mg/day in 3 divided doses), or placebo for 8 weeks. The primary efficacy variables were changes in anxiety as determined by final on-therapy HAM-A total and psychic anxiety scores and Clinical Global Impressions scale (CGI) scores. Other key efficacy variables were HAM-A anxious mood and tension scores and the anxiety subscale scores of the patient-rated Hospital Anxiety and Depression scale (HAD). RESULTS: The efficacy analysis included 365 patients and the safety analysis, 405. At week 8, adjusted mean HAM-A psychic anxiety, anxious mood, and tension scores were significantly lower for venlafaxine XR-treated patients than for placebo-treated patients. On the HAD anxiety subscale, venlafaxine XR, 75 or 150 mg/day, was significantly more efficacious than placebo at all time points except weeks 1 (both dosages) and 2 (150-mg/day dosage only) and significantly more efficacious than buspirone at all time points except week 1. On the CGI-Improvement scale, scores for venlafaxine XR (both dosages) and buspirone were numerically superior to those for placebo at all time points, and statistical significance was observed at weeks 3, 4, 6, and 8 for venlafaxine XR and at weeks 6 and 8 for buspirone. The adverse events were not essentially different between treatment groups. CONCLUSION: Venlafaxine XR is an effective, safe, and well-tolerated once-daily anxiolytic agent in patients with GAD without comorbid major depressive disorder. This agent was significantly superior to buspirone on the HAD anxiety subscale. Buspirone demonstrated statistical significance versus placebo on a measure of anxiolytic response.

Ambulatory Care↗
PubMed1999

The underrecognition and undertreatment of depression: what is the breadth and depth of the problem?

Currently, 1 in 6 of the population will, at some point during their lives, suffer from major depression. By the year 2020, it has been estimated that major depression will be the second most important cause of disability worldwide. Major depression is associated not only with significant morbidity, but with comorbid chronic illnesses and lost productivity because of excess mortality and morbidity. The most important reason for the recognition and adequate treatment of depression is that symptoms can be effectively controlled. Despite this, patients are frequently neither recognized nor treated adequately. Underdiagnosis and undertreatment of major depression can be associated with factors relating to patients, their physicians, and the health care systems that provide their care. The treatment of depressed patients with appropriate agents, at appropriate doses, for appropriate periods of time, and incorporating appropriate nonpharmacologic strategies, is cost-effective. Since much of the management of depression occurs in primary care, approaches aimed at improving the overall management of the condition have a major role to play in lessening the burden of the disease.

Antidepressive Agents↗
PubMed1999

Management of posttraumatic stress disorder: diagnostic and therapeutic issues.

Although the hallmark symptoms of posttraumatic stress disorder (PTSD) are clear, this disorder is not always properly diagnosed. Reasons for misdiagnosis include a high rate of comorbidity, patient denial or minimization, overly high diagnostic thresholds set by clinicians, or failure to take a trauma history. There are a number of challenges associated with the treatment of PTSD. Patients with PTSD may not respond to pharmacotherapy in the same manner, and it is unclear whether this is related to gender, trauma type, or other factors. Antidepressants, particularly the selective serotonin reuptake inhibitors, are the most effective form of pharmacotherapy for patients with PTSD. Patients also may respond to therapy with monoamine oxidase inhibitors or tricyclic antidepressants. Psychosocial techniques, such as cognitive-behavioral therapy or stress inoculation training, are effective and may be considered as adjunctive therapy with medication. As awareness of PTSD increases, more patients should receive an accurate diagnosis and appropriate therapy.

Behavior Therapy↗
PubMed1998

Generalized anxiety disorder: neurobiological and pharmacotherapeutic perspectives.

The concept of generalized anxiety has evolved over many years, from initial descriptions of "anxiety neurosis" to recognition of generalized anxiety disorder (GAD) as a clinical entity included in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. Since 1980, the definition of GAD has undergone further change, with modifications in the salience of autonomic and panic like symptoms, duration, and allowance of comorbidity. The importance of these historical considerations lies in the fact that most of our current knowledge about GAD rests on outdated definitions, including most of the literature pertaining to treatment. Indeed, we cannot be sure that the DSM-III definition of GAD bears resemblance to the current concept, and these differences may have profound implications for findings from research. The following two-part report comprises i) a review of the basic neurobiology of GAD, with reference to serotonergic, noradrenergic, neuroendocrine, autonomic imaging, and other systems; and ii) an overview of the current status of pharmacotherapy for GAD.

Anti-Anxiety Agents↗
PubMed1998

Discontinuation of clonazepam in the treatment of social phobia.

Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for longterm clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper.

Adult↗
PubMed1998

Treatment of posttraumatic stress disorder with nefazodone.

Selective serotonin reuptake inhibitors are useful in the treatment of posttraumatic stress disorder (PTSD), but have a number of side-effects which limit their acceptability. A newer serotonergic compound, nefazodone, has a different side-effect profile, thus making it a potentially promising compound to study. Seventeen private practice patients with PTSD were treated with nefazodone up to 600 mg/day for a maximum total treatment period of 12 weeks. All subjects were civilians, and were monitored for efficacy and side-effects at weeks 1, 2, 4, 6, 8 and 12. Nefazodone was associated with statistically significant improvement in mean scores on all six rating scales used to assess change from baseline in PTSD symptoms. Additionally, statistically significant improvement from baseline were seen for the intrusive, avoidant/numbing, and hyperarousal clusters on a global PTSD scale. Early improvements in nightmares and general sleep disturbance were observed. Overall, there was a 43% response rate at endpoint, or 60% in treatment completers, by observer rating. Side-effects (assessed on the Medication Effects Scale) were generally benign. Nefazodone was associated with clinical improvement in this population, and now needs to be studied in double-blind, placebo controlled, protocols.

Adolescent↗
PubMed1998

Panic disorder and social phobia: current treatments and new strategies.

Panic disorder and social phobia are among the most disabling of the anxiety disorders. The emotional cost to the patient suffering from these diagnoses is exceeded only by the very real economic costs to the community because of reduced productivity, lost workdays, and increased health care costs for associated physical complaints. It is imperative, therefore, that the medical community focus on the accurate diagnosis and effective treatment of these potentially devastating conditions. Pharmacologic treatments for panic disorder and social phobia have been available since the early 1960s. The limited efficacy and significant side effects of the early medications, however, led to a search for new treatment options. For many years, the benzodiazepines were the principal first-line therapy for treatment of these illnesses. Yet, their potential for cognitive impairment, physiological dependence, abuse, and withdrawal phenomena warranted a continued search for newer agents with an improved safety profile. In the last 10 years, several treatments have been identified that may fill this need. Controlled trials and/or anecdotal reports have shown SSRIs and anticonvulsants to be effective treatments for the symptoms of panic disorder and social phobia. However, although SSRIs are emerging as a leading treatment for generalized social phobia, it is not at all clear whether they can benefit nongeneralized social phobia. Their side-effect profile, while a marked improvement over earlier antidepressant drugs, still can cause significant discomfort. The anticonvulsants are now emerging as a very important group of drugs in the anxiety disorders, with gabapentin having been the most extensively studied in social phobia.

Acetates↗
PubMed1998

Open trial of nefazodone for combat-related posttraumatic stress disorder.

BACKGROUND: Because of its ability to block 5-HT2 receptors postsynaptically and inhibit 5-HT reuptake presynaptically and/or its enhancement of sleep quality, nefazodone may be useful for symptom management in posttraumatic stress disorder (PTSD) patients. METHOD: Ten patients with combat-related DSM-IV posttraumatic stress disorder (PTSD) entered an open-label 12-week trial of nefazodone with a 4-week follow-up, beginning with 100 mg/day and increasing as necessary to achieve a maximal response or until reaching a maximum dosage of 600 mg/day. RESULTS: Nefazodone was well tolerated, and no significant changes in sexual function were reported. Based on Clinical Global Impressions-Improvement scores, all 10 patients were rated as much improved. All PTSD symptoms (except self-reported PTSD reexperiencing symptoms), sleep, and clinician-rated depression significantly improved at week 12. At follow-up, significant changes were maintained, and self-reported PTSD reexperiencing symptoms had also significantly improved. Effect sizes for all changed symptoms were moderate to large at week 12 and at follow-up. Self-reported and clinician-rated anger significantly improved. Self-reported depression failed to improve. Improvement in social and occupational functioning was minimal. CONCLUSION: These preliminary data suggest that nefazodone may be effective in reducing the 3 primary PTSD symptom clusters and may be particularly helpful in improving sleep and decreasing anger.

Adult↗
PubMed1998

Bupropion sustained release: a therapeutic overview.

Sustained-release bupropion (bupropion SR) represents a new form of an already known effective antidepressant drug. Its pharmacokinetics, mechanism of action, metabolism, and efficacy are reviewed. Benefit relative to placebo has been demonstrated in two large multicenter trials, with low doses (100 or 150 mg) having been shown to have therapeutic efficacy. An overview of all placebo-controlled trials of bupropion SR is given, and the differential properties of bupropion and serotonergic drugs are described. The concept of a catecholamine-indolamine spectrum is presented, along with its implications for possible differential therapeutics of selective antidepressants.

1-Naphthylamine↗
PubMed1998

Pivotal studies of clonazepam in panic disorder.

Clonazepam has recently been approved for the treatment of panic disorder. Two large placebo-controlled efficacy trials were completed; superior benefit was found for the drug on most measures. The studies are reviewed in relation to the criteria set forth by Shear and Maser with respect to design, diagnostic, and outcome measures. Most, but not all, recommended measures were used. Measurement of panic attack severity, duration, and frequency were generally the least satisfactory of all outcome variables and failed to provide the consistent benefit that was found with other measures. A slow discontinuation phase was employed, and a benign withdrawal course was noted, although withdrawal from higher doses was associated with more emergent symptomatology.

Clonazepam↗
PubMed1998

The long-term treatment of panic disorder.

Panic disorder is a chronic and recurring condition, and there is therefore a need for long-term therapy. This paper reviews data from long-term studies of drug treatment for panic disorder to address issues of whether medication benefits persist, whether improvement can continue over several months or years, the tolerability of long-term treatment, patient selection for long-term treatment, and when and how to stop medication. The main conclusion is that long-term drug treatment of panic disorder is necessary, effective, and safe. Serotonin selective reuptake inhibitors offer benefits of ease of dosing, good tolerability, and no safety or dependence problems; TCAs are often poorly tolerated, and benzodiazepines are associated with dependence problems. Withdrawal from all types of medication should be considered, slow, planned, and individualized; some patients require an indefinite duration of treatment.

Antidepressive Agents, Tricyclic↗
PubMed1998

Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Four faculty invited by the chairman also participated: David S. Baldwin, Johan A. den Boer, Siegfried Kasper, and M. Katherine Shear. EVIDENCE: The consensus statement is based on the 6 review papers that are published in this supplement and on the scientific literature relevant to these issues. CONSENSUS PROCESS: There were group meetings held during a 2-day period. On day 1, the group discussed each review paper and the chairman and discussant (Dr. Kasper) identified key issues for further debate. On day 2, the group discussed these key issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chairman and approved by all attendees. CONCLUSIONS: The consensus statement provides standard definitions for response and remission and identifies appropriate strategy for the management of panic disorder in a primary care setting. Serotonin selective reuptake inhibitors are recommended as drugs of first choice with a treatment period of 12 to 24 months. Pharmacotherapy should be discontinued slowly over a period of 4 to 6 months.

Antidepressive Agents↗
PubMed1998

Homeopathic and psychiatric perspectives on grief.

OBJECTIVE: This review describes the homeopathic analysis of grief and common remedies corresponding to this reaction. Homeopathic descriptions of grief are compared with contemporary psychiatric criteria. DATA SOURCES: Each homeopathic rubric (i.e., symptom) is identified on the basis of a computerized repertory search, grouped according to body systems, and compared with a current set of operational criteria derived from the psychiatric literature. The major homeopathic remedies for grief are identified. STUDY SELECTION: One hundred four rubrics for grief were found, incorporating mental and physical symptoms as well as physical disease. DATA SYNTHESIS: Homeopathic phenomenology of grief was closely matched with its current psychiatric definition. A close correspondence was seen between psychiatry and homeopathy, even though each has a differing heritage and temporal origin. The correspondence of a later descriptive system (i.e., psychiatry) to an earlier, independently derived system (i.e., homeopathy) confers validation to both systems' description of the grief response. CONCLUSION: The similarities and differences between homeopathic and psychiatric descriptions of grief have been noted. Similar forms of grief response are recognized by both systems, though homeopathy provides a more extensive list of physical sequelae following bereavement. Controlled trials of homeopathy in grief states are recommended.

Grief↗
PubMed1998

Pharmacotherapy of social anxiety disorder.

Antidepressants and high-potency benzodiazepines have been used successfully to treat patients with social anxiety disorder. This review considers the efficacy of irreversible and reversible inhibitors of monoamine oxidase, selective serotonin reuptake inhibitors, high-potency benzodiazepines, and beta-blockers and presents the response rates for each of these classes. Aspects of the social anxiety syndrome that are sensitive to drug treatment are discussed, and the data relating to relapse following treatment discontinuation are presented. Predictors for negative treatment outcome following completion of acute treatment trials are reviewed.

Adrenergic beta-Antagonists↗
PubMed1998

Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: The goal of this consensus statement is to provide primary care clinicians with a better understanding of management issues in social anxiety disorder (social phobia) and guide clinical practice with recommendations for appropriate pharmacotherapy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Julio Bobes, Deborah C. Beidel, Yukata Ono, and Herman G. M. Westenberg. EVIDENCE: The consensus statement is based on the 7 review papers published in this supplement and on the scientific literature relevant to the issues reviewed in these papers. CONSENSUS PROCESS: The group met over a 2-day period. On day 1, the group discussed each review paper, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSIONS: The consensus statement underlines the importance of recognizing social anxiety disorder and provides recommendations on how it may be distinguished from other anxiety disorders. It proposes definitions for response and remission and considers appropriate management strategies. Selective serotonin reuptake inhibitors are recommended as first-line therapy, and effective treatment should be continued for at least 12 months. Long-term treatment is indicated if symptoms are unresolved, the patient has a comorbid condition or a history of relapse, or there was an early onset of the disorder.

Anxiety Disorders↗