An open-label trial of risperidone augmentation for refractory anxiety disorders.
ABSTRACT There is a paucity of data to support "next-step" treatments for the many patients with anxiety disorders who remain symptomatic after initial pharmacotherapy.
Thirty patients with a primary diagnosis of an anxiety disorder-panic disorder (PD), social anxiety disorder (SAD), or generalized anxiety disorder (GAD)-refractory to initial pharmacotherapy with an adequate (or maximally tolerated) antidepressant and/or benzodiazepine trial of at least 8 weeks' duration prior to study initiation received open-label augmentation with flexibly dosed risperidone for 8 weeks. Participants were diagnosed using the Structured Clinical Interview for DSM-IV.
Risperidone augmentation at a mean +/- SD dose of 1.12 +/- 0.68 mg/day (range, 0.25-3.00 mg/day) resulted in a significant reduction in anxiety symptoms across disorders as measured by the Clinical Global Impressions-Severity of Illness scale and Hamilton Rating Scale for Anxiety (HAM-A) scores and for each disorder-specific primary outcome measure-the Panic Disorder Severity Scale, the Liebowitz Social Anxiety Scale, and HAM-A-in the intent-to-treat sample. Seventy percent (21/30) of participants completed the 8-week trial, with premature discontinuation due primarily to sedation and weight gain.
Although conclusions are limited by the open-label, relatively brief nature of this trial, our data suggest that augmentation with low-dose risperidone may be a useful option for patients with PD, SAD, or GAD refractory to adequate initial intervention with antidepressants and/or benzodiazepines. Longer-term, controlled safety and efficacy data are needed to understand the place of risperidone augmentation in the algorithm of treatment options for refractory anxiety disorders.
- SourceAvailable from: Maurice Preter
- [Show abstract] [Hide abstract]
ABSTRACT: Social anxiety disorder, also called social phobia, is a disorder characterized by extreme fear and/or avoidance of social or performance situations that involve evaluation or possible scrutiny by others. This disorder encompasses both isolated performance anxiety and generalized fears of many social encounters, leading to significant impairment and dysfunction in social, family, educational, and occupational functioning. It is often complicated by the presence of comorbid mood disor- ders, such as depression, and alcohol and substance use disorders. This article reviews the epidemiology, associated impair- ment, comorbidity, and treatment of social anxiety disorder, including pharmacotherapy and psychosocial therapies.