Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder

Anxiety disorders and PTSD are common and increasing worldwide. Current medications help some patients but have side effects and do not address underlying brain changes. After a period of stagnation, there is renewed interest in developing new drug treatments. This review describes currently available drugs and summarizes recent and ongoing clinical trials of novel medicines, grouped by their neurochemical targets: monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic, and neuropeptide systems. The authors emphasize designing treatments based on an understanding of neurobiology and harnessing neuroplasticity to produce lasting beneficial changes, for example by combining psychotropic drugs with psychotherapy. Emerging trends in this new phase of drug development are noted.

Study at a glance

Abstract

Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic approaches, including medication, are effective in alleviating symptoms of anxiety disorders and posttraumatic stress disorder (PTSD), at least in some individuals, but have unwanted side-effects and do not resolve underlying pathophysiology. After a period of stagnation, there is renewed enthusiasm from public, academic and commercial parties in designing and developing drug treatments for these disorders. Here, we aim to provide a snapshot of the current state of this field that is written for neuropharmacologists, but also practicing clinicians and the interested lay-reader. After introducing currently available drug treatments, we summarize recent/ongoing clinical assessment of novel medicines for anxiety and PTSD, grouped according to primary neurochemical targets and their potential to produce acute and/or enduring therapeutic effects. The evaluation of putative treatments targeting monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic and neuropeptide systems, amongst others, are discussed. We emphasize the importance of designing and clinically assessing new medications based on a firm understanding of the underlying neurobiology stemming from the rapid advances being made in neuroscience. This includes harnessing neuroplasticity to bring about lasting beneficial changes in the brain rather than - as many current medications do - produce a transient attenuation of symptoms, as exemplified by combining psychotropic/cognitive enhancing drugs with psychotherapeutic approaches. We conclude by noting some of the other emerging trends in this promising new phase of drug development.