Anxiety disorders are chronic conditions with a relapsing/remitting time course with evidence coming from cross-sectional, retrospective and, in part, prospective studies. Moreover, it has to be acknowledged that the natural history of anxiety disorders is frequently complicated by Axis I and Axis II comorbidities. In fact, it has been estimated that 73% of patients with panic disorder have other comorbid conditions ranging from major depression to substance abuse until Axis II disorders, mostly the cluster C type. As such, it seems evident that any long-term treatment strategy for anxiety disorders has to take into account all these possible complications that may develop during the longitudinal phase of the disease.
Anxiety disorders are chronic conditions that may require long-term drug treatments. Antidepressants represent the current gold standard but they fail in up to one-third of patients. Moreover, benzodiazepines, currently used in the acute treatment, are limited by the high risk of tolerance, dependence, and abuse.
This paper is aimed at reviewing international literature on the use of anticonvulsant drugs in anxiety disorders.
References were identified by searches of Medline/PubMed and PsychINFO. Only papers published in English were reviewed.
Despite a considerable number of open studies and anecdotal reports, the number of controlled studies is scanty. The majority of publications have several methodological limitations including inadequate sample size; lack of placebo control; the use of different outcome measures; and lack of controlling for patient variables such as comorbidity, diagnostic subtype, and concomitant medications. Pregabalin is the only anticonvulsant with good evidence in generalized anxiety disorder. Pregabalin and gabapentin may be promising in social phobia but further controlled studies are needed. A number of compounds are still at an early stage of evidence and may deserve further controlled trials: topiramate in posttraumatic stress disorder and obsessive compulsive disorder, valproate and gabapentin in panic disorder.
Anticonvulsant drugs may be valuable options in some selected patients with difficult to treat anxiety disorders refractory to first-line agents. Further studies are warranted to identify specific clinical phenotypes where anticonvulsants may be successfully used in the acute and long-term treatment of anxiety disorders.
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