Researchers from Switzerland and the United States found that so-called benzodiazepine drugs, such as Ativan, Xanax and Valium, exert a calming effect by boosting action of a neurotransmitter called gamma-aminobutyric acid (GABA) in the same way as addictive drugs like opioids and cannabinoids.

This in turn activates the gratification hormone, dopamine, in the brain, the scientists said, showing that the same brain “reward pathways” are used by both types of drugs.

The findings may help in developing a next generation of non-addictive benzodiazepines, they wrote in the journal Nature.

Roche’s drug Valium, known generically as diazepam, is the best known of the benzodiazepine class of drugs, which have dominated the anxiety medicine market since the 1960s.

It and Ativan were among a host of other prescription drugs found in the blood of American pop star Michael Jackson when he died in June last year.

The study found that benzodiazepines seemed to work by binding to a particular part of the GABA, which the researchers named as the alpha1 sub-unit of the GABA type A receptor.

The findings show that developing similar benzodiazepines that bind to a different part may offer the same drug benefits without the addictive side effects, they said.

A study published earlier this month found that people with higher levels of dopamine in the brain tend to be more prone to addictive behavior.

Drug companies have been trying for some time to develop next-generation benzodiazepines by tweaking their chemical make-up to deliver a more selective effect that avoids unwanted side effects, but it has so far proved an uphill struggle.

German scientists conducting early research into a new compound said last year they thought they may have found a better anxiety drug which could counteract panic attacks without the side effects of existing drugs.

In 2003 Merck & Co abandoned work on another potential anxiety drug known as GABA Alpha 2/Alpha 3, after mid-stage clinical trial results were disappointing.

(Editing by Jon Boyle/David Stamp)

Technorati Tags: addictive drugs, anxiety drug addiction, Ativan, Valium

The practice can control problem behaviors, but can also threaten physical health. Since the U.S. Food and Drug Administration instituted a “black box” warning in 2005, one study found a 19 percent decrease in the prescription of atypical antipsychotics in elderly people with dementia. But the researchers found that in 2008, antipsychotics still represented 9 percent of all prescriptions in this group.

“The [2005] safety warning pertained to an increased risk of death among individuals using these drugs, so the public health ramifications of use of these drugs in elderly people with dementia, often in nursing homes, which we consider a vulnerable population, is concerning,” said Dr. E. Ray Dorsey, an assistant professor of neurology at the University of Rochester Medical Center and lead author of one of the studies in the Jan. 11 issue of the Archives of Internal Medicine.

Antipsychotics, developed to treat psychiatric conditions such as bipolar disorder and schizophrenia, are widely used “off label” to control difficult behavior in elderly people with dementia.

Indeed, Dorsey said he suspects that the vast majority of the use documented in his research is “off label.”

In the United States, no antipsychotics are approved to calm behavior, although one such drug, risperidone (Risperdal), is approved for that indication in Canada. Black box warnings are rare for off-label use.

“There’s a real disconnect between the evidence and the prescribing patterns,” said Becky A. Briesacher, co-author of the second study, also in the Jan. 11 issue of Archives, and an associate professor of medicine at the University of Massachusetts Medical School in Worcester.

Briesacher’s study concluded that seniors who were admitted to nursing homes that already had high rates of prescribing antipsychotics were more likely to get these drugs as well, indicating that an “organizational culture” may be driving the trend.

But according to Dr. Davangere Devanand, director of geriatric psychiatry at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons in New York City, there’s little else to control aggression and agitation.

“The only medications that have been shown to work are antipsychotics, but the problem is they have side effects so you get into a situation where it may work in some patients but it may cause some significant side effects in some patients. It’s a balance,” he said.

Dorsey’s study looked mainly at atypical antipsychotic drug use — meaning second-generation drugs. Clozapine, the first atypical antipsychotic, was introduced in the United States in 1989 and later was followed by risperidone, olanzapine and paliperidone, according to background information with the study.

The researchers looked at the number of times the subject of antipsychotics was brought up during doctors’ office visits.

Between the beginning of January 2003 and March 2005, these mentions accelerated at a rate of 34 percent per year, 16 percent among elderly patients with dementia.

In the year after the advisory was issued, mention of atypical drugs dropped 2 percent overall and 19 percent among the dementia population. The declines were evident within one month of the warning.

And by 2008, antipsychotic use among this older population decreased more than 50 percent.

It’s not clear if that drop was “enough,” or if the drugs are still being overprescribed, said Dorsey.

“Whether or not 19 percent is an appropriate decrease or not is uncertain,” he said. “We can say that atypical antipsychotics are commonly prescribed, they have no indication for this use and there is limited evidence for their efficacy,” he added.

Devanand said “overuse” is difficult to define. “I don’t think we have any way to know what overuse is. No one knows what the use should be,” he said.

The second study found that almost one-third of residents in nursing homes were prescribed antipsychotics and that one-third of that number did not have dementia or psychosis.

Newly arrived residents were more likely to receive this type of drug if they were in a nursing home that routinely prescribed such drugs, suggesting that organizational culture and not patients are driving the trend.

“If you enter a nursing home that has a higher proportion of people on antipsychotics, you are also likely to be put on antipsychotics,” Briesacher said.

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They said 73 percent more adults and 50 percent more children are using drugs to treat mental illness than in 1996.

Among adults over 65, use of so-called psychotropic drugs — which include antidepressants, antipsychotics and Alzheimer’s medicines — doubled between 1996 and 2006.

“What we generally find is there has been an increase in access to care for all populations,” said Sherry Glied of Columbia University in New York, whose study appears in the journal Health Affairs.

“Mental health has become much more a part of mainstream medical care,” Glied said in a telephone interview.

In 2006, they said 16 percent of adults 65 and older had some form of mental health diagnosis.

The researchers culled data from several large public surveys of health in the United States, including from the National Center for Health Statistics, the Agency for Healthcare Research and Quality, the Substance Abuse and Mental Health Services Administration and the Social Security Administration.

Glied said expanded drug coverage under Medicare, the federal insurance program for the elderly, and the State Children’s Health Insurance Program for poor children, helped make such drugs more affordable.

The study found the number of children diagnosed and treated for mental health conditions by their primary care doctor doubled between 1996 and 2006.

“The increases in prescription drug use were particularly rapid in the early part of this decade, between 1996 to 2001,” Glied said. “For most groups, they have slowed down since then.”

The researchers did not report total numbers of people treated or calculate the dollar value of the drugs taken.

One worrisome finding, Glied said, was that there has been little progress in access to care among people with more serious mental illness. They found treatment for older adults with mental limitations who need help dressing, eating, or bathing fell between 1996 and 2006.

About 7 percent of Americans with serious mental illness wind up in jail or prison every year, the researchers said.

“New policies are desperately needed to reduce the flow of people whose primary problem is a mental disorder into the criminal justice system,” wrote Glied and colleague Richard Frank of Harvard Medical School.

While the study shows expanded mental health coverage for people with insurance, especially for those covered in government health plans, they said the ongoing recession and swelling ranks of the uninsured will likely mean less mental health coverage for many Americans in the near future.

(Editing by Maggie Fox)

Technorati Tags: Alzheimers medicines, antidepressants, antipsychotics, mental disorder, Mental Health, mental health diagnosis, psychotropic drugs

Generalized Anxiety Disorder

Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Anxiety Disorder Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms.

Anxiety Disorder Formal diagnosis: When someone spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.

Anxiety Disorder Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Panic Disorder

People with panic disorder experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment.

Panic Disorder Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.

Panic Disorder Formal Diagnosis: Either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep.

Panic Disorder Treatment: Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered “gold standards” for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms. Proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks.

Phobias

Most of us steer clear of certain, hazardous things. Phobias however, are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.

Phobias Symptoms: Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias.

Phobias Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.

Phobias Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.

Post-traumatic Stress Disorder

Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person’s ability to hold a job or to develop intimate relationships with others.

Post-traumatic Stress Disorder Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. People with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks.

Post-traumatic Stress Disorder Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.

Post-traumatic Stress Disorder Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti-anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.

Source: Samhsa.gov

Technorati Tags: anxiety disorder, anxiety disorder treatment, panic disorder, panic disorder treatment, phobia, phobia treatment, post-traumatic stress disorder

That’s according to a Norwegian study published in the latest edition of the journal Sleep.

The study defines chronic insomnia as the subjective feeling of having trouble falling or staying asleep most nights for at least a month.

People with chronic insomnia should be screened to see if they have an anxiety disorder or depression, note the researchers. They included Dag Neckelmann, MD, PhD, of the psychiatry department at Haukeland University in Bergen, Norway.

Neckelmann’s team tracked depression, anxiety, and insomnia in more than 25,000 Norwegian adults.

Participants completed a health survey that included questions about chronic insomnia, anxiety disorders, and depression. They took the survey twice — once in the mid-1980s and again 11 years later.

Insomnia, Anxiety Disorders, and Depression

The researchers excluded participants who had anxiety disorders or depression at the time of the first survey.

People who reported chronic insomnia in the first survey were particularly likely to note anxiety disorders in the follow-up survey 11 years later.

Chronic insomnia didn’t predict depression’s development. People with chronic insomnia in the first survey weren’t especially likely to report depression 11 years later in the second survey.

But that doesn’t mean that insomnia and depression weren’t related.

People with chronic insomnia were more likely to have current anxiety or depression than people without insomnia.

The results held when the researchers considered other factors, including participants’ age, sex, and educational level.
Sound Sleep, Less Anxiety?

Easing chronic insomnia might help prevent the development of anxiety disorders, Neckelmann’s team notes.

However, they didn’t test that theory directly. Their study doesn’t prove that insomnia causes anxiety disorders, or that ending insomnia heads off anxiety.

SOURCES: Neckelmann, D. Sleep, July 1, 2007; vol 30: pp 873-880. News release, American Academy of Sleep Medicine.

© 2007 WebMD Inc. All rights reserved.

Technorati Tags: anxiety disorders, anxiety research, chronic insomnia, depression, insomnia

The disorder leaves many isolated, ashamed and often misdiagnosed. Thirty-six percent of those with social anxiety disorder have symptoms for 10 years or more before seeking help, the Anxiety Disorders Association of America reports.

“Social anxiety disorder is when somebody has an intense, persistent and irrational fear of social or performance situations,” Jerilyn Ross, the association’s president and CEO, said during a teleconference Wednesday.

“The condition causes people to avoid common, everyday situations and even other people for fear of being judged or criticized or humiliated or embarrassing themselves,” Ross said.

Social anxiety disorder can interfere with daily routines and job performance, Ross noted. “It also makes it very difficult for people to develop friends and romantic partnerships,” she said.

People with this disorder recognize their fear is excessive and irrational, Ross noted. “But they feel powerless to do anything about it,” she said.

Social anxiety disorder can start in the early teens, Dr. Mark H. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders and a professor of psychiatry at Harvard Medical School, said during the teleconference.

“This is a disorder that starts affecting people early on,” Pollack said. “The typical age of onset is early adolescence, age 12 or 13, and many individuals report a history of anxiety dating back to earlier childhood.”

The disorder also has physical symptoms, including heart palpitations, feelings that their throat will close up, sweating, blushing, faintness, trembling and stammering, Ross said.

In the survey, pollsters questioned 578 people with anxiety, 276 people with obsessive-compulsive disorder, and 287 people with social anxiety disorder.

Among people with the disorder, 75 percent said the condition affected their ability to do normal activities. In addition, 69 percent said they didn’t want people to think they were crazy, and 58 percent said they were embarrassed by their condition, Ross said.

However, when the condition is diagnosed and treated, many reported improvement in their lives. In fact, 59 percent who were receiving treatment said treatment had a positive effect on their ability to have a romantic relationship. In addition, 39 percent who had received treatment said knowing that treatment can be successful aided their decision to get help, Ross noted.

The disorder can be effectively treated. Among the techniques that have been successful is cognitive behavior therapy, which helps people get a sense of control over their lives, Ross said.

In addition, relaxation techniques and medications have also been effective. Combination therapy that includes behavior therapy and medications has also been effective. Commonly prescribed medications include various types of antidepressants.

Among other key survey findings were:

* Thirty-four percent reported that their condition caused serious fights with their significant others.
* Seventy-seven percent said the disorder negatively impacted their romantic relationships.
* Thirty-five percent said having social anxiety disorder made them avoid intimacy.
* Twenty-four percent reported that the disorder resulted in their significant other not respecting them.
* Fifty-five percent said they had no close friends.
* Sixty-six percent reported having misunderstandings with friends, and 50 percent said they did not tell their friends about their symptoms.
* More than 60 percent didn’t keep in touch with friends or answer or return their phone calls.

SOURCES: April 9, 2008, teleconference with: Jerilyn Ross, president and CEO, Anxiety Disorders Association of America; Mark H. Pollack, M.D., director, Center for Anxiety and Traumatic Stress Disorders, and professor, psychiatry, Harvard Medical School, Boston

By Steven Reinberg
HealthDay Reporter