Changes in the drug treatment of anxiety disorders

One of the major changes in the clinical treatment of anxiety has been the substitution of benzodiazepines for less safe sedative-hypnotic drugs. A second major change has been the finding that antidepressants suppress panic attacks. The evidence for this is reviewed in this paper. It appears that panic anxiety is qualitatively different from other kinds of anxiety; this has important implications for diagnosis and treatment. Other clinical issues presented in this symposium are a review of benzodiazepine and new, non-benzodiazepine anxiolytic drugs, the treatment of separation anxiety, and the relationship of mitral valve prolapse to anxiety. Further advances are likely to depend both on our understanding of benzodiazepine and gamma-aminobutyric acid receptors and on drug models for inducing anxiety. The fact that antidepressants suppress panic attacks, and the ability to produce panic attacks in the laboratory opens up a number of possibilities for the investigation of the physiological basis of panic attacks. All of these topics are taken up in this symposium.