The functional anatomy, neurochemistry,
and pharmacology of anxiety

by
Ninan PT
Emory University School of Medicine,
Atlanta, GA 30329, USA.
J Clin Psychiatry 1999; 60 Suppl 22:12-7


ABSTRACT

The functional anatomy of anxiety involves amygdala-based neurocircuits with critical reciprocal connections to the medial prefrontal cortex. Traumatic experiences leave emotional imprints involving the amygdala, with facilitated fear-conditioned associations involving declarative memory traces. Avoidance conditioning is an additional component. An understanding of the functional anatomy of anxiety allows for a new perspective on the various anxiety disorders. The neurotransmitters involved in these circuits are reviewed for their relevance to the pharmacologic choices in the treatment of anxiety. Potent serotonin reuptake inhibitors appear to have superior efficacy in many of the anxiety disorders, with indications that norepinephrine reuptake inhibitors have an advantage in severe forms of major depression. Medications with dual effects--blocking reuptake of both serotonin and norepinephrine (e.g., clomipramine and venlafaxine XR)--have superior benefits in achieving remission in major depression and GAD. These medications may also offer a faster onset of action and theoretically superior benefits in patients with comorbid anxiety disorder and major depression.
GAD
SSRIs
Stress
F11440
Anxiety
Gepirone
Buspirone
Alprazolam
Adinazolam
Barbiturates
Benzodiazepines
Anxiety resources
Future anxiolytics
Making animals cry
Anxiety and depression
Subthreshold syndromes
Better anti-anxiety drugs
Buspirone plus venlafaxine
Neuropepide Y and anxiety
Anxiolytics/antidepressants
Generalised Anxiety Disorder (GAD)
Neurobiology and genetics of anxiety


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