5-HT3 and cholecystokinin receptor antagonists with anxiolytic properties threaten a further round of the 'tranquilizers or treatment' debate. Tricyclic antidepressants have been shown to enhance the effect of exposure therapy upon agoraphobic patients, and it can be argued that the therapeutic success of cognitive therapy in the treatment of anxiety disorders depends upon guided exposure to threatening situations. A consideration of the effects of agents already in use for the treatment of anxiety, and experimental and neuroanatomical findings, suggests that pathological anxiety might well include relatively independent abnormalities of autonomic regulation and psychological reactivity. Proper evaluation of these new compounds is therefore going to require careful evaluation of their cognitive and behavioural effects, as well as their physiology. This work should, therefore, draw the contributions of clinical pharmacology and clinical psychology closer together rather than drive them further apart.
Get full access to this article
View all access options for this article.
References
1.
Akiskal H.S. (1985) Anxiety: definition, relationship to depression, and proposal for an integrated model. In Tuma A H, Maser J D (eds), Anxiety and the anxiety disorders. Erlbaum, Hillsdale, pp. 787-797
2.
Blessing W.W., Goodchild A.K., Dampney R A L, Chalmers J.P. (1981) Cell groups in the lower brain stem of the rabbit projecting to the spinal cord, with special reference to catecholamine-containing neurons. Brain Res221: 35-55
3.
Charney D.S., Heninger G.R., Sternberg D.E., Roth R.H. (1981) Plasma MHPG in depression: effects of acute and chronic desipramine treatment. Psychiatr Res5: 217-229
4.
Clark D.M. (1986) A cognitive approach to panic. Behav Res Ther24: 461-470
5.
Clark D.M., Salkovskis P.M., Gelder M., Koehler C., Martin M., Anastasiades P., Hackmann A., Middleton H., Jeavons A. (1988) Tests of a cognitive theory of panic. In Hand I, Wittchen H U (eds), Panic and phobias 2. Springer-Verlag, Berlin, pp. 149-158
6.
Egan K.J., Carr J.E., Hunt D.D., Adamson R. (1988) Endogenous opiate system and systemic desensitisation . J Consulting Clin Psychol56: 287-291
7.
Elam M., Svensson T.H., Thoren P. (1985) Differentiated cardiovascular afferent regulation of locus coeruleus neurons and sympathetic nerves. Brain Res358: 77-84
8.
Foa E.B., Kozak M.J. (1986) Emotional processing of fear: Exposure to corrective information. Psychol Bull99: 20-35
9.
Hsiao J.K., Potter W.Z. (1990) Mechanisms of action of antipanic drugs. In Ballenger J C (ed.), Clinical aspects of panic disorder. Wiley-Liss, New York, pp. 297-317
10.
Hughes J., Boden P., Costall B., Domeney A., Kelly E., Horwell D.C., Hunter J.C., Pinnock R.D., Woodruff G.N. (1990) Development of a class of cholecystokinin type B receptor antagonists having potent anxiolytic activity. Proc Natl Acad Sci USA87: 6728-6732
11.
Jones B.J., Costall B., Domeney A.M., Kelly M.E., Naylor R.J., Oakley N.R., Tyers M.B. (1988) The potential anxiolytic activity of GR38032F, a 5-HT3-receptor antagonist. Br J Pharmacol93: 985-993
12.
Lang P.J. (1967) Fear reduction and fear behaviour: Problems in treating a construct. In Shlien J M (ed.), Research in psychotherapy, Vol. III. American Psychological Association, Washington.
13.
Linnoila M., Karoum F., Potter W.Z. (1982) Effect of low-dose clorgyline on 24 hour urinary monoamine excretion in patients with rapidly cycling bipolar affective disorder . Arch Gen Psychiatr39: 513-516
14.
Lucock M.P., Salkovskis P.M. (1988) Cognitive factors in social anxiety and its treatment . Behav Res Ther26: 297-302
15.
Lydiard R.B., Ballenger J.C., Laraia M., Potter W.Z., Lake R. ( 1986) Noradrenergic measures before and after treatment with tricyclics and benzodiazepines in agoraphobic and panic disorder patients . Presented at the American Psychiatric Association Meeting, Washington DC
16.
Mathews A., MacLeod C. (1986) Discrimination of threat cues without awareness in anxiety states. J Abnormal Psychol95: 131-138
17.
Mavissakalian M., Michelson L. (1986) Relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine treatment of agoraphobia. Am J Psychiatr143: 1106-1112
18.
Mavissakalian M., Michelson L., Dealy R.S. (1983) Pharmacological treatment of agoraphobia: imipramine vs imipramine with programmed practice. Br J Psychiatr143: 348-355
19.
Michelson L., Marchione K., Greenwald M., Glanz L., Testa S., Marchione N. (1990) Panic disorder: Cognitive-behavioural treatment . Behav Res Ther28: 141-151
20.
Nutt D., Middleton H., Franklin M. (1987) The neuroendocrine effects of oral imipramine. Psychoneuroendocrinology12: 1-9
21.
Nutt D.J., Glue P. ( 1989) Clinical pharmacology of anxiolytics and antidepressants; a psychopharmacological perspective. Pharmacol Ther44: 309-334
22.
Potter W.Z., Sceinin M., Golden R.N., Rudorfer M.V., Cowdry R., Calil H.M., Ross R.J., Linnoila M. (1985) Selective antidepressants and cerebrospinal fluid . Arch Gen Psychiatr42: 1171-1177
23.
Rachman S., Hodgson R. (1974) Synchrony and desynchrony in fear and avoidance . Behav Res Ther12: 311-318
24.
Risby E.D., Hsiao J.K., Golden R.N., Potter W.Z. (1987) Intravenous alprazolam challenge in normal subjects . Presented at the Society for Biological Psychiatry , Chicago
25.
Ross R.J., Zavadil A.P., Calil H.M., Linnoila M., Kitanaka I., Blombery P., Kopin I.J., Potter W.Z. (1983) Effects of desmethylimipramine on plasma norepinephrine, pulse and blood pressure. Clin Pharmacol Ther33: 429-437
26.
Salkovskis P.M. (1986) The cognitive revolution: New way forward, backward somersault or full circle? Behav Psychother14: 278-282
27.
Salkovskis P.M., Westbrook D. (1989) Behaviour therapy and obsessional ruminations: Can failure be turned into success? Behav Res Ther27: 149-160
28.
Stratton J.R., Halter J.B. (1985) Effect of a benzodiazepine (alprazolam) on plasma epinephrine and norepinephrine levels during exercise stress. Am J Cardiol56: 136-139
29.
Telch M.J., Agras W.S., Taylor C.B. (1985) Combined pharmacological and behavioural treatment for agoraphobia. Behav Res Ther23: 325-335
30.
Warwick H M C., Salkovskis P. (1990) Hypochondriasis. Behav Res Ther28: 105-117
31.
Wessely S., David A., Butler S., Chalder T. (1989) Management of chronic (post-viral) fatigue syndrome . J R Coll Gen Practitioners39: 26-29
32.
Wolpe J. (1958) Psychotherapy by reciprocal inhibition. Stanford, California, Stanford University Press
33.
Ziegler G., Ludwig L., Klotz U. (1984) Stress protective effects during steady state conditions of bromazepam. Pharmacopsychiatry17: 194-198
34.
Zitrin C.M., Klein D.F., Woerner M.C. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Arch Gen Psychiatr37: 63-72
35.
Zitrin C.M., Klein D.F., Woerner M.G. (1983) Treatment of phobias—1. Comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatr40: 125-138
