Treatment-refractory anxiety; definition, risk factors, and treatment challenges

Figures & data

Figure 1. Paroxetine treatment of social anxiety disorder.

Adapted from ref 115: Stein MB, Liebowitz MR, Lydiard RB, Pitts CD, Bushnell W, Gergel I. Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. JAMA. 1998;280(8):708-713.

Figure 2. Treatment intolerance: high rate of negative placebo response in panic disorder.²⁴ GAD, generalized anxiety disorder; MDD, major depressive disorder

Figure 3. Disturbed spouse and family relationships predict lack of remission in generalized anxiety disorder.⁴⁰

Figure 4. Response rates for cognitive behavioral therapy (CBT) vs treatment as usual (TAU) in medication-resistant anxiety: the CALM study.⁷¹

Figure 5. Generalized anxiety disorder with depressive symptoms: could benzodiazepines make anxiety worse? BZD, benzo-diazepine.104

*Imipramine/diazepam>placebo P<0.05.

**Imipramine>diazepam P<0.05.

LoebelAD.HydeTS.DunnerDL.Early placebo response in anxious and depressed patients.J Clin Psychiatry.19864752302333516977

 PubMed Web of Science ®Google Scholar

YonkersKA.DyckIR.WarshawM.KellerMB.Factors predicting the clinical course of generalised anxiety disorder.Br J Psychiatry.200017654454910974960

 PubMed Web of Science ®Google Scholar

Roy-ByrneP.CraskeMG.SullivanG.et alDelivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial.JAMA.19 2010303191921192820483968

 PubMed Web of Science ®Google Scholar

RickelsK.DowningR.SchweizerE.HassmanH.Antidepressants for the treatment of generalized anxiety disorder. A placebo-controlled comparison of imipramine, trazodone, and diazepam.Arch Gen Psychiatry.199350118848958215814

 PubMed Web of Science ®Google Scholar