Treatment Advances on Horizon For Mood, Anxiety Disorders

What is the current status of treatments for various mood and anxiety disorders? Might any new treatments be emerging during the next five to 10 years?

A research leader in this area—Dennis Charney, M.D., chief of the mood and anxiety disorders research program of the National Institute of Mental Health—gave some answers to these questions at a Washington, D.C., meeting in April. It was sponsored by the National Association of Psychiatric Health Systems and was attended by the CEOs of a number of private psychiatric hospitals throughout the United States.

Major Depression

The selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat major depression, work by essentially the same mechanism—blocking the reuptake of the nerve transmitters norepinephrine and serotonin. Thus, four drug companies are conducting trials to see whether antagonists to the receptor for the neuropeptide substance P might prove to be an effective new class of drugs for depression, Charney said. Such drugs may not turn out to be any more effective than the SSRIs, he continued, but they do not seem to lead to sexual dysfunction, which is a common side effect of the SSRIs.

Other promising new treatments for depression are antagonists to corticotropin-releasing factor (CRF), since CRF has been found in high levels in depressed persons (Psychiatric News, May 4).

“Several companies are in the race for an effective compound,” Charney said.

Anxiety

Many people who have a diagnosis of depression also have an anxiety disorder; thus, both disorders probably have a similar biology. And because of the putatively similar biology underlying the two disorders, it is hardly surprising that the SSRIs can counter anxiety as well as depression, said Charney. What’s more, evidence is emerging that the SSRIs can also combat anxiety in children. For instance, Daniel Pine, M.D., a child psychiatrist and head of the NIMH’s section on development and affective neuroscience, and his colleagues conducted a study showing that the SSRI fluvoxamine can alleviate social phobia, separation anxiety disorder, and generalized anxiety disorder in children and adolescents. Their results are reported in the April 26 New England Journal of Medicine(Psychiatric News, May 18).

“I think this is a potentially important study,” Charney commented, but investigators should also determine whether various kinds of psychotherapies might benefit anxious children.

Bipolar Illness

Atypical antipsychotics have been shown to prevent mania in bipolar patients. So if a patient’s mania is poorly controlled with lithium, for example, antipsychotics may help. But the down side of such drugs—weight gain—also needs to be considered.

There are a lot of problems with bipolar illness, a lot of relapses. “We need new drugs for bipolar illness in a serious way,” Charney asserted.

There is an especially pressing need for effective and safe drugs for children who have bipolar illness. For instance, there is evidence that lithium can help these children, but questions remain about its effects on their developing brains. Untreated bipolar illness, however, isn’t good for their developing brains either.

Other Disorders

The tricyclic antidepressants are probably still the best treatment for obsessive-compulsive disorder, said Charney, and researchers need to break new ground here.

Also, the recently approved abortion pill, RU-486, may have some therapeutic effects against psychotic depression, a disease normally difficult to treat, he pointed out.

An abstract of “Fluvoxamine for the Treatment of Anxiety Disorders in Children and Adolescents” is posted on the Web at www.nejm.org/content/2001/0344/0017/1279.asp. ▪