Valproic acid for the treatment of social anxiety disorder
The aim of the study was to examine the efficacy of valproic acid in participants with social anxiety disorder. Following a 2-week single-blind, placebo run-in period, 17 participants were enrolled in a 12-week open flexible-dose trial of valproic acid (500-2500 mg). The primary outcome measures were the mean change from baseline in the Liebowitz Social Anxiety Scale (LSAS) total score and responder status [defined as a Clinical Global Impression of Improvement score (CGI-I) < or =2]. Social anxiety symptoms as measured by the LSAS and CGI-I scores significantly improved with treatment. The mean reduction in the LSAS was 21.3 points in the last visit carried forward analysis and 19.1 points for the completer analysis, with 41.1% and 46.6% participants, respectively, achieving responder status. The results from this open-label trial suggest the potential efficacy of valproic acid for the treatment of social anxiety disorder. Placebo-controlled trials are indicated to confirm these findings.
Available from: Arnim Quante
- "Furthermore, benzodiazepines may actually cause a worsening of depressive symptoms in patients with major depression if used long term (Hicks et al., 1988). Various anticonvulsant drugs, such as Carbamazepine or Valproate, have been used in the treatment of mood and anxiety disorders (Lipper et al., 1986; Tondo et al., 1989) as they have been found to be effective mood stabilizers in patients with bipolar disorder (Yatham et al., 2002) and are also beneficial in the treatment of anxiety disorders (Kinrys et al., 2003). Pregabalin, a gamma-aminobutyric acid analog, has been shown to have an acute anxiolytic effect in patients with generalized anxiety disorder (Pande et al., 2003; Pohl et al., 2005; Strawn and Geracioti, 2007) as well as being effective in long-term relapse prevention in patients with generalized anxiety disorder (Feltner et al., 2008). "
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ABSTRACT: Abstract Symptoms of anxiety are common in patients with depression. In this retrospective case series we investigated the effect of Pregabalin as an add-on medication in unipolar depressed patients with high levels of anxiety. The therapeutic effect of Pregabalin showed a fast onset and was comparable to the anxiolytic effect of benzodiazepines.
Available from: PubMed Central
- "Open-label trials of valproate,77 topiramate,78 and tiagabine79 have also been reported, all of which showed reductions in relevant social phobia rating scales. All studies were small (involving 17–54 subjects), and the magnitude of the change in symptom ratings was within the range that has been reported for placebo arms in other RCT. "
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ABSTRACT: This article proposes a number of recommendations for the treatment of generalized social phobia, based on a systematic literature review and meta-analysis. An optimal treatment regimen would include a combination of medication and psychotherapy, along with an assertive clinical management program. For medications, selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles. The nonselective monoamine oxidase inhibitor, phenelzine, may be more potent than these two drug classes, but because of its food and drug interaction liabilities, its use should be restricted to patients not responding to selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. There are other medication classes with demonstrated efficacy in social phobia (benzodiazepines, antipsychotics, alpha-2-delta ligands), but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines, it is unclear how best to incorporate these drugs into treatment regimens. There are very few clinical trials on the use of combined medications. Cognitive behavior therapy appears to be more effective than other evidence-based psychological techniques, and its effects appear to be more enduring than those of pharmacotherapy. There is some evidence, albeit limited to certain drug classes, that the combination of medication and cognitive behavior therapy may be more effective than either strategy used alone. Generalized social phobia is a chronic disorder, and many patients will require long-term support and treatment.
Available from: Ozalp Ekinci
- "The possible psychiatric and/or therapeutic effects of AED also deserve attention. Some AED including valproate, gabapentin, tiagabine and vigabatrine have been reported to anxiolytic effects and have been used with varying success in the treatment of anxiety disorders in adult studies (Johannessen Landmark, 2008; Kinrys et al., 2003; Blanco et al., 2003, Pande et al., 2000,2003; Rosenthal, 2003). Several hypotheses and suggestions have been made for why some AEDs have anti-anxiety effects (Ketter et al., 1999). "
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