Serotonergic drugs in the treatment of depressive and anxiety disorders

Serotonergic dysfunction has been implicated in the aetiology of several ps ychiatric conditions, including depressive and anxiety disorders. Much of t he evidence for the role of serotonin (5-HT) in these disorders comes from treatment studies with serotonergic drugs, including selective serotonin re uptake inhibitors (SSRIs), 5-HT1A agonists and 5-HT antagonists. This revie w considers the place of these drugs in the treatment of panic disorder, ob sessive-compulsive disorder (OCD), social phobia, and generalized anxiety d isorder (GAD). Among these agents, the SSRIs stand out with proven efficacy in the treatment of a spectrum of disorders, such as depression, panic dis order, OCD and social phobia. They may also be a suitable treatment for GAD . 5-HT1A agonists have been used extensively for the treatment of depressio n and GAD, but evidence of their efficacy in other anxiety disorders is equ ivocal. 5-HT antagonists are the least well studied of these agents: while they may have activity in depression, their efficacy has not been fully inv estigated in anxiety disorders. However, preliminary reports suggest that t hey may be useful as adjuvants to SSRIs in treatment-refractory OCD. The hi gh incidence of comorbidity amongst psychiatric disorders means that pharma cotherapy that is effective against a range of disorders, such as the SSRIs , is of considerable use to clinicians. Future research into the biological mechanisms underlying such disorders is likely to further enhance pharmaco therapy. Copyright (C) 2000 John Wiley & Sons, Ltd.