Anxiety is a phenomenon which falls within both normal experience and ill health. As a pathological condition it exerts a heavy toll on society, both in social and economic terms. The classification of anxiety disorders has developed with successive revisions of the major diagnostic manuals. Although symptomatogy is shared, differentiation is based upon aetiology, intensity and time course and has resulted in an attempt at more precisely targeted treatment strategies. The challenge now is for better recognition and diagnosis of anxiety disorders and an improved armamentarium with which to treat them.
This volume is a most welcome critical review of those anxiolytics currently available as well as some long awaited compounds which may be added to our formularies in the future. It begins with a consideration of the benzodiazepines, of which the more potent, long acting members of this group, although far from ideal, are still the most effective agents currently available for the treatment of acute anxiety.
Dealing with chronic anxiety disorders can also be a difficult and unrewarding task, with antidepressants, old and new, as well as buspirone, often proving less than satisfactory in this respect. Such existing strategies are covered from a detailed clinical as well as a pharmacological perspective in individual chapters, with each one critically reviewing in some detail the evidence for efficacy of the various compounds available in the treatment of specific anxiety disorders. The chapter on the selective serotonin reuptake inhibitors (SSRIs) is particularly useful in view of the current competition between manufacturers to gain an ever-increasing share of the world market.
The book continues with detailed discussion of the possibility of benzodiazepine receptor ligands as future anxiolytics as well as an authoritative consideration of the roles of 5-HT receptors subtypes and peptides in the aetiology of anxiety. It provides an interesting historical perspective on the so far unfruitful quest for a selective 5-HT1A agonist as monotherapy for anxiety. Additionally, descriptions of the potential development of 5-HT2C agonists and antagonists as well as NMDA receptor antagonists as new treatments for anxiety disorders brings the reader up-to-date with what is currently occupying the minds of researchers in their quest for more specific treatment strategies.
Each chapter is written by an acknowledged expert, active in the field. It is extremely well referenced with a useful index. Clearly intended for an international market of researchers, academics as well as clinicians and students of the subject. It is well organized, easy to read with short chapters and clear concise explanations of the pharmacology as far as current knowledge permits, although at times, translation from the native tongue of some of the authors leaves a little to be desired.
As a general read, in order to be up to date with current and future developments, as well as a useful reference tool for aiding the selection of appropriate therapy for difficult cases, this volume is a necessary addition to the library of anyone with a either a clinical or an academic interest in anxiety disorders and their treatment.