Valproate in anxiety and withdrawal syndromes

Various anticonvulsant medications may have efficacy in the treatment of certain anxiety states as well as withdrawal syndromes occurring after the discontinuation of sedative-hypnotic drugs and alcohol. Preclinical studies and limited anecdotal evidence suggest that valproate may be more effective in controlling panic than carbamazepine. In small studies valproate and carbamazepine have been shown as possible effective agents in the treatment of alcohol withdrawal. Some treatment-resistant patients with panic disorder may respond well to trials of certain anticonvulsants. It is also possible that some patients in the heterogeneous generalized anxiety disorder category may respond to valproate and carbamazepine, particularly in light of the similarity between this type of anxiety and the symptoms of alcohol and sedative-hypnotic drug withdrawal. While benzodiazepines clearly have an important role in the treatment of anxiety and withdrawal states, the role of nonbenzodiazepine anticonvulsants is a promising one which needs to be further delineated with careful, controlled studies.