Emory Report

July 24, 2000

 Volume 52, No. 38

Scholarship & Research

New drug examined as anxiety disorder treatment

By Lillian Kim

Emory is launching a study of a new drug for the treatment of generalized anxiety disorder (GAD), a condition characterized by chronic, excessive worry that persists at least six months and is not associated with any particular event.

The drugs generally used to treat GAD are "benzodiazepines," a class that includes Xanax, Valium and Klonopin; "azaspirones," of which the drug BuSpar is a member; and an antidepressant, Effexor XR, which recently received an indication from the Food and Drug Administration for treatment of GAD.

While benzodiazepines are effective against GAD, they have two drawbacks: They do not treat depression, which commonly occurs in tandem with GAD, and they can cause physiological dependence. The latter can result in increased anxiety and, in rare instances, seizures if the drug treatment is halted too abruptly. BuSpar also does not treat depression.

Thus, there is a need for other drugs that are effective in treating depression as well as GAD.

"Close to 90 percent of people with GAD who are seen in a psychiatry setting have another psychiatric disorder," said Jeffrey Kelsey, the study's principal investigator and director of the Mood and Anxiety Disorders Clinical Trials Program at Emory.

Kelsey will be assessing the effectiveness of S-citalopram, a close chemical relative of the antidepressant Celexa.

GAD affects roughly one in 20 people, but its symptoms-which include fatigue, irritability, stomach distress, sleeplessness, restlessness, headaches and muscle tension-may account for up to a quarter of primary care practice visits. Irritability, muscle aches and pains, and difficulty controlling worry are common complaints in many medical practices.

People with GAD tend to have trouble concentrating and consequently may perform below their capability at work or in school. However, many of those affected by GAD are only mildly impaired, and continue to function relatively well.

GAD, which often strikes in childhood or adolescence, differs from panic disorder in that GAD is defined by a constantly heightened sense of anxiety that lasts at least six months. By contrast, people with panic disorder generally experience normal anxiety levels, punctuated with episodes of extreme anxiety. Post-traumatic stress disorder also causes excessive anxiety, but the anxiety is centered on a specific event.

People with GAD often tend to "catastrophize," or believe that the worst possible scenario will occur, said Kelsey, also an assistant professor of psychiatry and behavioral sciences.

People with GAD swap possibility with probability; they ignore a highly probable positive outcome and fix upon a remotely possible negative result.

While people with GAD can be successfully treated, they generally do not improve spontaneously on their own. Besides medication, another treatment option for GAD is psychotherapy, such as cognitive behavioral therapy.

For more information about the study, call 404-727-8968.

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