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Anxiety Disorders: HELP
Articles by Siegfried Kasper
Based on 44 articles published since 2009
(Why 44 articles?)
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Between 2009 and 2019, S. Kasper wrote the following 44 articles about Anxiety Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. 2012

Bandelow, Borwin / Sher, Leo / Bunevicius, Robertas / Hollander, Eric / Kasper, Siegfried / Zohar, Joseph / Möller, Hans-Jürgen / Anonymous4290724 / Anonymous4300724. ·Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany. Borwin.Bandelow@medizin.uni-goettingen.de ·Int J Psychiatry Clin Pract · Pubmed #22540422.

ABSTRACT: OBJECTIVE: Anxiety disorders are frequently under-diagnosed conditions in primary care, although they can be managed effectively by general practitioners. METHODS: This paper is a short and practical summary of the World Federation of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) for the treatment in primary care. The recommendations were developed by a task force of 30 international experts in the field and are based on randomized controlled studies. RESULTS: First-line pharmacological treatments for these disorders are selective serotonin reuptake inhibitors (for all disorders), serotonin-norepinephrine reuptake inhibitors (for some) and pregabalin (for generalized anxiety disorder only). A combination of medication and cognitive behavior/exposure therapy was shown to be a clinically desired treatment strategy. CONCLUSIONS: This short version of an evidence-based guideline may improve treatment of anxiety disorders, OCD, and PTSD in primary care.

2 Editorial Editorial. 2018

Kasper, Siegfried. · ·World J Biol Psychiatry · Pubmed #30175952.

ABSTRACT: -- No abstract --

3 Editorial Editorial. 2017

Kasper, Siegfried. · ·World J Biol Psychiatry · Pubmed #28262034.

ABSTRACT: -- No abstract --

4 Editorial Editorial. 2016

Kasper, Siegfried. · ·World J Biol Psychiatry · Pubmed #26820607.

ABSTRACT: -- No abstract --

5 Editorial Editorial. 2015

Kasper, Siegfried. · ·World J Biol Psychiatry · Pubmed #26637050.

ABSTRACT: -- No abstract --

6 Editorial Third issue of 2013. 2013

Kasper, Siegfried. · ·Int J Psychiatry Clin Pract · Pubmed #23971671.

ABSTRACT: -- No abstract --

7 Review Silexan in anxiety disorders: Clinical data and pharmacological background. 2018

Kasper, Siegfried / Müller, Walter E / Volz, Hans-Peter / Möller, Hans-Jürgen / Koch, Egon / Dienel, Angelika. ·a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria. · b Department of Pharmacology Biocenter , Goethe-University , Frankfurt , Germany. · c Psychotherapy and Psychosomatic Medicine , Hospital for Psychiatry , Werneck , Germany. · d Clinic for Psychiatry and Psychotherapy , Ludwig Maximilians University , Munich , Germany. · e Research and Development Department, Dr. Willmar-Schwabe GmbH & Co. KG , Karlsruhe , Germany. ·World J Biol Psychiatry · Pubmed #28511598.

ABSTRACT: OBJECTIVES: Silexan is a lavender oil preparation available in 80-mg capsules. Here we review clinical trials investigating its anxiolytic efficacy, safety and tolerability in humans, as well as preclinical investigations supporting this therapeutic use. METHODS: Besides three selected publications reporting preclinical investigations, seven clinical trials are included, of which five had a treatment duration of 6 or 10 weeks. Primary outcome measure was the HAM-A total score reduction, while single items were assessed with regard to effects on concomitant depressive symptoms and on quality of sleep. RESULTS: In patients with subthreshold (subsyndromal) anxiety or generalised anxiety disorder (GAD), an anxiolytic effect of Silexan was evident after 2 weeks. HAM-A total score reductions between baseline and end of treatment were significantly superior to placebo in patients with subthreshold anxiety and comparable with those achieved under lorazepam or paroxetine in patients with GAD. In addition, Silexan had beneficial effects on typical concomitant symptoms of anxiety disorders, such as impaired sleep, somatic complaints, co-morbid depression or decreased quality of life. Except for mild gastrointestinal symptoms, Silexan did not induce any adverse effects and did not cause drug interactions, sedation or withdrawal symptoms at daily doses of 80 or 160 mg. CONCLUSIONS: Silexan is a safe and effective treatment in anxiety disorders.

8 Review Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis. 2017

Generoso, Marcelo B / Trevizol, Alisson P / Kasper, Siegfried / Cho, Hyong J / Cordeiro, Quirino / Shiozawa, Pedro. ·aClinical Neuromodulation Laboratory, Department of Psychiatry, Santa Casa School of Medical Sciences, Sa[Combining Tilde]o Paulo, Brazil bDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria cDepartment of Psychiatry, University of California (UCLA), Los Angeles, California, USA. ·Int Clin Psychopharmacol · Pubmed #27643884.

ABSTRACT: Generalized anxiety disorder (GAD), characterized by pervasive and highly distressing anxiety and worries, is associated with severe impairment. Although numerous agents from various drug classes are available to treat GAD, as many as 50% of patients have inadequate response, constituting an important medical frontier. In the face of this challenge, new pharmacological alternatives need to be further studied aiming at clinical improvement and better quality of life for patients. To assess the efficacy of pregabalin (PGB) compared with placebo for amelioration of anxiety symptoms in patients with GAD. A systematic literature search was performed using databases such as MEDLINE and EMBASE and other sources. The main outcome was Hedges' g for continuous scores. We used a random-effects model. Heterogeneity was evaluated with the I (moderate heterogeneity was assumed if I was >50% and high heterogeneity if I was >75%) and the χ-test (P<0.10 for heterogeneity). Publication bias was evaluated using the funnel plot. Meta-regression was performed using the random-effects model. For safety evaluation, we compared patients' dropout rates. We included eight randomized-controlled trials (n=2299) in our study, comparing the use of PGB in different dosages and placebo. In terms of the main outcome, PGB was found to be superior to the placebo group (Hedges' g=0.37; 95% confidence interval 0.30-0.44). The funnel plot assessment showed a low risk of publication bias. Between-study heterogeneity was not significant (I=0%), strengthening our results. Meta-regression showed no particular influence of any variable on the results. A categorical analysis of safety, using dropout as the most severe possible outcome, was carried out. No difference between PGB and placebo groups was observed in terms of the dropout rates. PGB was superior to placebo for the amelioration of GAD symptoms. In addition, the dropout rate was not significantly higher than that of the placebo groups. PGB was comparable to benzodiazepines in clinical response, but had lower dropout rates than benzodiazepine.

9 Review The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice. 2016

Möller, Hans-Jürgen / Bandelow, Borwin / Volz, Hans-Peter / Barnikol, Utako Birgit / Seifritz, Erich / Kasper, Siegfried. ·Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstrasse 7, 80336, Munich, Germany. · Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, 37075, Göttingen, Germany. · Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany. · Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University Medical Center Cologne, Cologne, Germany. · Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Albertus Magnus University of Cologne, Joseph Stelzmann Strasse 20, 50937, Cologne, Germany. · Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, Lenggstrasse 31, 8032, Zurich, Switzerland. · Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. sci-biolpsy@meduniwien.ac.at. ·Eur Arch Psychiatry Clin Neurosci · Pubmed #27002521.

ABSTRACT: According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

10 Review The serotonin transporter in psychiatric disorders: insights from PET imaging. 2015

Spies, Marie / Knudsen, Gitte M / Lanzenberger, Rupert / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. · Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. · Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Electronic address: sci-biolpsy@meduniwien.ac.at. ·Lancet Psychiatry · Pubmed #26249305.

ABSTRACT: Over the past 20 years, psychotropics affecting the serotonergic system have been used extensively in the treatment of psychiatric disorders. Molecular imaging, in particular PET, has allowed for elucidation of the essential contribution of the serotonin transporter to the pathophysiology of various psychiatric disorders and their treatment. We review studies that use PET to measure cerebral serotonin transporter activity in psychiatric disorders, focusing on major depressive disorder and antidepressant treatment. We also discuss opportunities and limitations in the application of this neuroimaging method in clinical practice. Although results from individual studies diverge, meta-analysis indicates a trend towards reduced serotonin transporter availability in patients with major depressive disorder. Inconsistencies in results might suggest symptom heterogeneity in major depressive disorder and might therefore be relevant for stratification of patients into clinical subsets. PET has enabled the elucidation of mechanisms of response to selective serotonin reuptake inhibitors (SSRIs) and hence provides a basis for rational pharmacological treatment of major depressive disorder. Such imaging studies have also suggested that the pattern of serotonin transporter binding before treatment might predict response to antidepressant treatment, which could potentially be clinically useful in the future. Additionally, this Review discusses PET studies investigating the serotonin transporter in anxiety, obsessive-compulsive disorder, and eating disorders. Few studies have shown changes in serotonin transporter activity in schizophrenia and attention deficit hyperactivity disorder. By showing the scarcity of data in these psychiatric disorders, we highlight the potential for further investigation in this field.

11 Review Gut emotions - mechanisms of action of probiotics as novel therapeutic targets for depression and anxiety disorders. 2014

Slyepchenko, Anastasiya / Carvalho, Andre F / Cha, Danielle S / Kasper, Siegfried / McIntyre, Roger S. ·Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. Roger.McIntyre@uhn.ca. ·CNS Neurol Disord Drug Targets · Pubmed #25470391.

ABSTRACT: A priority clinical and research agenda in mood and anxiety disorders is to identify determinants that influence illness trajectory and outcome. Over the past decade, studies have demonstrated a bidirectional relationship between the gut microbiome and brain function (i.e., the microbiota-gut-brain axis). Probiotic treatments and developmental analysis of the microbiome may provide potential treatments and preventative measures for depressive and anxiety disorders. This systematic literature review aims to identify original studies linking the gut microbiota to major depressive disorder and anxiety disorders. Furthermore, this review searched for original reports focusing on possible therapeutic and preventative effects of probiotics for these debilitating conditions. Accumulating data indicate that the gut microbiota communicates with the CNS through neural, endocrine and immune pathways. Studies in germ-free animals indicate that the microbiota is involved in the regulation of the stress response (e.g., hypothalamic-pituitary-adrenal axis) and in CNS development at critical stages. Probiotics attenuate anxiety and depressive-like behaviors in experimental animal models. Notwithstanding some inconsistencies and methodological limitations across trials, clinical studies suggest that probiotics may mitigate anxiety symptoms. However, future studies should investigate the anxiolytic and antidepressant effects of probiotics in more phenotypically homogeneous populations. In conclusion, the emerging concept of a gut microbiota-brain axis suggests that the modulation of the gut microbiota may provide a novel therapeutic target for the treatment and/or prevention of mood and anxiety disorders.

12 Review An orally administered lavandula oil preparation (Silexan) for anxiety disorder and related conditions: an evidence based review. 2013

Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria. ·Int J Psychiatry Clin Pract · Pubmed #23808618.

ABSTRACT: OBJECTIVE: Silexan is a lavender oil preparation in gelatine capsules containing 80 mg. We reviewed the clinical trials investigating the anxiolytic efficacy and tolerability of Silexan as well as its safety and potential for drug interactions. METHODS: Seven trials were included, among which four therapeutic trials had a treatment duration of 6 or 10 weeks. RESULTS: In patients with subsyndromal anxiety or generalised anxiety disorder (GAD) an anxiolytic effect of Silexan was evident after 2 weeks. Patients treated with Silexan showed Hamilton Anxiety Scale (HAMA) total score decreases between 10.4 ± 7.1 and 12.0 ± 7.2 points at Week 6 and between 11.8 ± 7.7 and 16.0 ± 8.3 points at Week 10. CONCLUSIONS: HAMA total score reductions between baseline and end of treatment were significantly superior to placebo in patients with subsyndromal anxiety and comparable to lorazepam in its starting dose in patients with GAD. Silexan had beneficial effects on typical co-morbidity symptoms of anxiety disorders, for example, disturbed sleep, somatic complaints, or decreased quality of life. Except for mild gastrointestinal symptoms, the drug was devoid of adverse effects and did not cause drug interactions or withdrawal symptoms at daily doses of 80 or 160 mg.

13 Review Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. 2013

Dold, Markus / Aigner, Martin / Lanzenberger, Rupert / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria. ·Int J Neuropsychopharmacol · Pubmed #22932229.

ABSTRACT: Because of the high number of patients with obsessive-compulsive disorder (OCD) not responding satisfactorily to initial monotherapy with serotonin reuptake inhibitors (SRIs), the evaluation of additional treatment options is highly relevant. To examine efficacy of add-on pharmacotherapy with antipsychotics, a systematic literature search was applied to identify all double-blind, randomized, placebo-controlled trials (DB-PC-RCTs) determining the efficacy of antipsychotic augmentation of SRIs in treatment-resistant OCD. The primary outcome of the pooled meta-analytic data analysis was response to the adjunctive antipsychotic treatment measured by both the rates of participants achieving response [defined as ≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale (YBOCS)] and mean changes in YBOCS total score. Twelve DB-PC-RCTs investigating quetiapine (N = 5), risperidone (N = 3), olanzapine (N = 2), aripiprazole (N = 1) and haloperidol (N = 1) with a total of 394 subjects were included. Significantly more patients responded to augmentation with antipsychotics than with placebo [relative risk = 2.10, 95% confidence intervals (CI) 1.16-3.80]. Additionally, the mean reduction of the YBOCS total score revealed an efficacy in favour of the antipsychotic medication [standardized mean difference (SMD) = 0.54, 95% CI 0.15-0.93]. Significant efficacy was identifiable only for risperidone, but not for quetiapine and olanzapine. The results regarding aripiprazole and haloperidol were inconsistent. Overall, about one-third of SRI-resistant OCD patients benefited from an augmentation strategy with antipsychotics. Based on the favourable risk:benefit ratio, risperidone can be considered as the agent of first choice and should be preferred to quetiapine and olanzapine. Further trials, mainly with higher antipsychotic doses, are required to optimize pharmacological treatment recommendations for SRI-refractory OCD.

14 Review [The effects of hormone replacement therapy on mind and brain]. 2013

Baldinger, P / Kranz, G / Höflich, A / Savli, M / Stein, P / Lanzenberger, R / Kasper, S. ·Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich. ·Nervenarzt · Pubmed #22318360.

ABSTRACT: Hormonal fluctuations during the perimenopausal transition lead to physical discomfort but are also frequently accompanied by mood swings, depressive symptoms, anxiety and sleeping disorders. The important role of the neurotransmitter serotonin in the pathogenesis of anxiety disorders and major depression is unquestioned, but only little is known about the influence of sex hormones on the serotonergic system. This review provides an overview of potential risk factors for the occurrence of affective disorders in the menopausal transition and discusses possible therapeutic options. Current research findings from longitudinal studies testing the efficacy of hormone replacement therapy and antidepressants with effects on the serotonergic neurotransmission on physical and mental discomforts during menopause are presented. Furthermore, studies using positron emission tomography and genetic methods that explore the effects of sex steroids on different components of the serotonergic system are shown. The interactions between estrogen, progesterone and the serotonergic system are described, and possible neurobiological and endocrinological mechanisms underlying depressive symptoms in the perimenopause are elucidated.

15 Review [Efficacy of antipsychotic augmentation therapy in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomised, placebo-controlled trials]. 2011

Dold, M / Aigner, M / Lanzenberger, R / Kasper, S. ·Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien. markus.dold@lrz.tum.de ·Fortschr Neurol Psychiatr · Pubmed #21809258.

ABSTRACT: Only 40 - 60 % of all patients with obsessive-compulsive disorder (OCD) respond to serotonin reuptake inhibitors (SRIs). Therefore, the evaluation of additive treatment in the presence of treatment resistance has high clinical relevance. All double-blind, randomised, placebo-controlled trials that evaluated the efficacy of a combination therapy of SRIs and antipsychotics in treatment-resistant OCD were identified by systematic literature searches and combined in a meta-analysis. 11 studies with a total of 356 treatment-resistant patients were included. After the augmentation, significantly more subjects in the intervention groups (SRI + antipsychotic) fulfilled the response criterion (reduction in the Yale-Brown obsessive compulsive scale [Y-BOCS] ≥ 35 %) than in the control groups (SRI + placebo) (relative risk = 2.16). The subgroup analysis showed significant efficacy only for risperidone. Further significant differences have been found regarding the antipsychotic dosage and the SRI-treatment duration before the augmentation.

16 Review Efficacy and safety of silexan, a new, orally administered lavender oil preparation, in subthreshold anxiety disorder - evidence from clinical trials. 2010

Kasper, Siegfried / Gastpar, Markus / Müller, Walter E / Volz, Hans-Peter / Möller, Hans-Jürgen / Dienel, Angelika / Schläfke, Sandra. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. sci-biolpsy@meduniwien.ac.at ·Wien Med Wochenschr · Pubmed #21170695.

ABSTRACT: We review the data on the efficacy and tolerability of silexan, a novel preparation from lavender oil for oral use, in the treatment of anxiety disorders and related condition with particular attention to subthreshold generalized anxiety disorder (GAD). Three randomized, double-blind clinical trials were identified which investigated the efficacy of silexan in subsynromal anxiety disorder (vs. placebo; 10 weeks' treatment), in GAD (vs. lorazepam; 6 weeks), and in restlessness and agitation (vs. placebo; 10 weeks) according to DSM-IV and ICD-10 criteria. All trials assessed the participants' anxiety levels using the Hamilton Anxiety Scale (HAMA). Across all trials 280 patients were exposed to silexan 80 mg/day, 37 were treated with lorazepam 0.5 mg/day and 192 received placebo. Average within group HAMA total scores at baseline ranged between 24.7 and 27.1 points. Patients treated with silexan showed average HAMA total score decreases by between 10.4 ± 7.1 and 12.0 ± 7.2 points at week 6 and by between 11.8 ± 7.7 and 16.0 ± 8.3 points at week 10. In GAD silexan and lorazepam showed comparable HAMA total score reductions (90% CI for mean value difference: -2.3; 2.8 points).

17 Review Social anxiety disorder: epidemiology, biology and treatment. 2009

Fink, Martin / Akimova, Elena / Spindelegger, Christoph / Hahn, Andreas / Lanzenberger, Rupert / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria. ·Psychiatr Danub · Pubmed #19935490.

ABSTRACT: Social anxiety disorder (SAD) is considered to be one of the most common anxiety disorders. Despite its high prevalence, the disorder is still considerably underdiagnosed and undertreated. SAD shows a typically early onset in childhood or early adolescence and generally becomes chronic. The disease places a massive burden on patients lives, affecting not only their social interactions but also their educational and professional activities, thereby constituting a severe disability. Although substantial progress in the study of the etiology of SAD has been made, no commonly accepted model has emerged yet. Data from genetic and neuroimaging studies point towards a contribution of several neurotransmitter systems (i.e. norepinephrine, dopamine and serotonin) to the pathophysiology of this disorder. Functional magnetic resonance imaging studies have repeatedly emphasized the central role of the amygdalae and insula in the neural circuitry of the disorder. Selective serotonin reuptake inhibitors (SSRI) are commonly accepted as first line therapy, however other substance classes like serotonin norepineprine reuptake inhibitors (SNRI), monoamine oxidase inhibitors (MAOI), benzodiazepines and several other agents have also proved effective. There is still a substantial lack of data on therapeutic options in cases of non-responsive SAD as well as on add-on therapy. A combined treatment-approach including psychotherapy (e.g. cognitive behavioural therapy) may prove useful.

18 Review The role of pharmacogenetics in the treatment of depression and anxiety disorders. 2009

Schosser, Alexandra / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Austria. alexandra.schosser@meduniwien.ac.at ·Int Clin Psychopharmacol · Pubmed #19738481.

ABSTRACT: Although effective treatment for mood and anxiety disorders have been available for more than 40 years, 30-50% of depressed patients and 25% of patients with anxiety disorder do not respond sufficiently to first-line treatment with antidepressants. Genetic factors are supposed to play a major role in both variation of treatment response and incidence of adverse effects to medication. So far, candidate genes of pharmacokinetic and pharmacodynamic pathways of antidepressants have been investigated, and associations between several candidate genes and response to antidepressants are reported. Two functional polymorphisms of the serotonin transporter gene, 5-HTTLPR and STin2 have been investigated in a large number of pharmacogenetic studies of depression; other candidate genes include serotonin receptor genes, brain-derived neurotrophic factor, P-glycoprotein (located in the blood-brain barrier), G-proteins, TPH1 and TPH2, MAOA, the noradrenaline transporter gene, FKBP5, or cytochrome P450 (CYP450) genes. CYP450 genes play a major role in the metabolism of a substantial part of psychotropics, including antidepressants, and the first estimates of dosage adjustments for antidepressants have been provided based on metabolizer status. Genome-wide association studies that use large numbers of single-nucleotide polymorphisms to screen the entire genome for alleles that influence a trait are now feasible, and the results of the first genome-wide association studies of antidepressant treatment outcome will soon be available. The current review not only updates pharmacogenetic research in depression but also focuses on antidepressant treatment response in anxiety disorders.

19 Review The serotonin-1A receptor in anxiety disorders. 2009

Akimova, Elena / Lanzenberger, Rupert / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. ·Biol Psychiatry · Pubmed #19423077.

ABSTRACT: The serotonin system plays an important role in the neural processing of anxiety. The involvement of the main inhibitory serotonergic receptor, the serotonin-1A (5-HT1A) subtype, in dysfunctional forms of anxiety has been supported by findings from a wide range of preclinical research and clinical trials, including treatment studies, genetic research, and neuroimaging data. The following article summarizes preclinical results with a focus on 5-HT1A receptor knockout and transgenic mice as genetic models of anxiety. Behavioral, autonomic, and endocrinological changes in these mice are reported. This article also presents genetic polymorphisms in humans associated with increased anxiety scores and pharmacological data focused on 5-HT1A receptor agonists and antagonists. Furthermore, molecular neuroimaging results are presented. Recent positron emission tomography (PET) studies have reported reduced 5-HT1A receptor binding in patients with panic disorder and social anxiety disorder, but not in posttraumatic stress disorder. In healthy subjects, increased anxiety scores might be associated with lower 5-HT1A receptor binding. This overview of preclinical and clinical data provides strong evidence for the key role of the 5-HT1A receptor in the serotonergic dysregulation of anxiety disorders.

20 Article Efficacy of Silexan in subthreshold anxiety: meta-analysis of randomised, placebo-controlled trials. 2019

Möller, Hans-Jürgen / Volz, Hans-Peter / Dienel, Angelika / Schläfke, Sandra / Kasper, Siegfried. ·Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany. · Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany. · Department of Clinical Research 1, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany. · Department of Biostatistics, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany. · Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. sci-biolpsy@meduniwien.ac.at. ·Eur Arch Psychiatry Clin Neurosci · Pubmed #29150713.

ABSTRACT: Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included. Eligible participants with a baseline Hamilton Anxiety Rating Scale (HAMA) total score ≥ 18 points received 1 × 80 mg/day Silexan or placebo for 10 weeks. Outcomes included the HAMA, the Pittsburgh Sleep Quality Index, the Zung Self-rating Anxiety Scale, the Clinical Global Impressions questionnaire and the SF-36 health status inventory. Data were analysed using meta-analysis based on pooled raw data of individual patients (random effects models). A total of 697 patients were assessed for efficacy. Silexan was superior to placebo in reducing the HAMA total score during 10 weeks' treatment [mean value difference, 95% confidence interval: 3.83 (1.28; 6.37) points]. Superiority was comparably pronounced for psychic and somatic anxiety as well as for observer- and self-rated anxiety. Silexan had a beneficial effect on sleep (secondary to the anxiolytic effect) without causing sedation and improved the patients' health-related quality of life. Adverse event incidence in both treatment groups was comparable [risk ratio: 1.06 (0.85; 1.33)]. Silexan has a significant and clinically meaningful anxiolytic effect in subthreshold anxiety. The results cannot be generalised to other lavender oil products.

21 Article Low comorbid obsessive-compulsive disorder in patients with major depressive disorder - Findings from a European multicenter study. 2018

Dold, Markus / Bartova, Lucie / Souery, Daniel / Mendlewicz, Julien / Porcelli, Stefano / Serretti, Alessandro / Zohar, Joseph / Montgomery, Stuart / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. · Psy Pluriel, Centre Européen de Psychologie Médicale, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium. · Université Libre de Bruxelles, Brussels, Belgium. · Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy. · Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel. · Imperial College, University of London, London, United Kingdom. · Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Electronic address: gen-psychiatry@meduniwien.ac.at. ·J Affect Disord · Pubmed #29107818.

ABSTRACT: BACKGROUND: This cross-sectional European multicenter study examined the association between major depressive disorder (MDD) and comorbid obsessive-compulsive disorder (OCD). METHODS: Socio-demographic, clinical, and treatment features of 1346 adult MDD patients were compared between MDD subjects with and without concurrent OCD using descriptive statistics, analyses of covariance (ANCOVA), and binary logistic regression analyses. RESULTS: We determined a point prevalence of comorbid OCD in MDD of 1.65%. In comparison to the MDD control group without concurrent OCD, a higher proportion of patients in the MDD + comorbid OCD group displayed concurrent panic disorder (31.81% vs 7.77%, p<.001), suicide risk (52.80% vs 44.81%, p=.04), polypsychopharmacy (95.45% vs 60.21%, p=.001), and augmentation treatment with antipsychotics (50.00% vs 25.46%, p=.01) and benzodiazepines (68.18% vs 33.31%, p=.001). Moreover, they were treated with higher mean doses of their antidepressant drugs (in fluoxetine equivalents: 48.99mg/day ± 18.81 vs 39.68mg/day ± 20.75, p=.04). In the logistic regression analyses, comorbid panic disorder (odds ratio (OR)=4.17, p=.01), suicide risk (OR=2.56, p=.04), simultaneous treatment with more psychiatric drugs (OR=1.51, p=<.05), polypsychopharmacy (OR=14.29, p=.01), higher antidepressant dosing (OR=1.01, p=<.05), and augmentation with antipsychotics (OR=2.94, p=.01) and benzodiazepines (OR=4.35, p=.002) were significantly associated with comorbid OCD. CONCLUSION: In summary, our findings suggest that concurrent OCD in MDD (1) has a low prevalence rate compared to the reverse prevalence rates of comorbid MDD in OCD, (2) provokes higher suicide risk, and (3) is associated with a characteristic prescription pattern reflected by a high amount of polypsychopharmaceutical treatment strategies comprising particularly augmentation with antipsychotics and benzodiazepines.

22 Article Silexan in generalized anxiety disorder: investigation of the therapeutic dosage range in a pooled data set. 2017

Kasper, Siegfried / Möller, Hans-Jürgen / Volz, Hans-Peter / Schläfke, Sandra / Dienel, Angelika. ·aDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria bClinic for Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich cHospital for Psychiatry, Psychotherapy and Psychosomatic Medicine, Schloss Werneck dDr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany. ·Int Clin Psychopharmacol · Pubmed #28379882.

ABSTRACT: Silexan, a special active substance produced from Lavandula angustifolia, is efficacious in subsyndromal anxiety at a dose of 80 mg/day, but its effective dosage in generalized anxiety disorder (GAD) has yet to be defined. In two double-blind, placebo-controlled trials, daily doses of 10, 40, 80, and 160 mg silexan were administered for 10 weeks. A total of 925 adults with GAD according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and a Hamilton Anxiety Scale (HAMA) total score of at least 18 points were analyzed for efficacy. We assessed the change versus baseline for the HAMA and the Covi Anxiety Scale, the Clinical Global Impressions scale, the Sheehan Disability Scale, and the SF-36 health status questionnaire using analysis of variance and covariance. Silexan 160 mg/day was superior to placebo for all efficacy outcomes investigated, with responder rates exceeding 60% on the basis of HAMA and Clinical Global Impressions criteria. For the 80 mg/day dosage, superiority over placebo could be shown in one trial as well as in the pooled analysis. The risk of adverse events under silexan was similar to placebo for all dosages investigated. In GAD silexan 160 mg/day is efficacious whereas 80 mg/day may represent the lower end of the therapeutic range. Daily doses up to 160 mg were well tolerated.

23 Article Silexan does not cause withdrawal symptoms even when abruptly discontinued. 2017

Gastpar, M / Müller, W E / Volz, H P / Möller, H J / Schläfke, S / Dienel, A / Kasper, S. ·a Fliedner Klinik Berlin , Berlin , Germany. · b Department of Pharmacology , Biocenter Goethe-University , Frankfurt , Germany. · c Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine, Schloss Werneck , Werneck , Germany. · d Clinic for Psychiatry and Psychotherapy , Ludwig Maximilians University , Munich , Germany. · e Dr. Willmar Schwabe GmbH & Co. KG , Karlsruhe , Germany. · f Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria. ·Int J Psychiatry Clin Pract · Pubmed #28319423.

ABSTRACT: OBJECTIVE: Subsequent to a randomised, double-blind, double dummy clinical trial assessing the efficacy of silexan compared to placebo and paroxetine in patients suffering from generalised anxiety disorder (GAD), a 1week follow-up phase was added in order to assess possible withdrawal symptoms of silexan after abrupt discontinuation. METHODS: Participants received silexan 80 mg/d, silexan 160 mg/d, paroxetine 20 mg/d, or placebo at a ratio of 1:1:1:1. Study medication was discontinued after the 10 week active treatment phase of the original trial. Whereas paroxetine was tapered as indicated, silexan administration was discontinued abruptly. Assessment of possible withdrawal effects was done using the Physician Withdrawal Checklist questionnaire (PWC-20). RESULTS: During the 1 week down-titration phase, mean total PWC-20 scores had reduced by 0.19 in placebo, 0.23 in silexan 80, 0.65 in silexan 160, and 0.51 in paroxetine. The median change in all four groups was 0.00. In none of the treatment groups withdrawal effects occurred after discontinuation. CONCLUSIONS: Values assessed for the silexan groups indicate the absence of a dependency potential of this preparation.

24 Article Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders - results from a European multicenter study. 2017

Dold, Markus / Bartova, Lucie / Souery, Daniel / Mendlewicz, Julien / Serretti, Alessandro / Porcelli, Stefano / Zohar, Joseph / Montgomery, Stuart / Kasper, Siegfried. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. · Université Libre de Bruxelles, Brussels, Belgium; Psy Pluriel, Centre Européen de Psychologie Médicale, Brussels, Belgium. · School of Medicine, Free University of Brussels, Brussels, Belgium. · Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy. · Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel. · Imperial College, University of London, London, United Kingdom. · Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Electronic address: sci-biolpsy@meduniwien.ac.at. ·J Psychiatr Res · Pubmed #28284107.

ABSTRACT: This naturalistic European multicenter study aimed to elucidate the association between major depressive disorder (MDD) and comorbid anxiety disorders. Demographic and clinical information of 1346 MDD patients were compared between those with and without concurrent anxiety disorders. The association between explanatory variables and the presence of comorbid anxiety disorders was examined using binary logistic regression analyses. 286 (21.2%) of the participants exhibited comorbid anxiety disorders, 10.8% generalized anxiety disorder (GAD), 8.3% panic disorder, 8.1% agoraphobia, and 3.3% social phobia. MDD patients with comorbid anxiety disorders were characterized by younger age (social phobia), outpatient status (agoraphobia), suicide risk (any anxiety disorder, panic disorder, agoraphobia, social phobia), higher depressive symptom severity (GAD), polypsychopharmacy (panic disorder, agoraphobia), and a higher proportion receiving augmentation treatment with benzodiazepines (any anxiety disorder, GAD, panic disorder, agoraphobia, social phobia) and pregabalin (any anxiety disorder, GAD, panic disorder). The results in terms of treatment response were conflicting (better response for panic disorder and poorer for GAD). The logistic regression analyses revealed younger age (any anxiety disorder, social phobia), outpatient status (agoraphobia), suicide risk (agoraphobia), severe depressive symptoms (any anxiety disorder, GAD, social phobia), poorer treatment response (GAD), and increased administration of benzodiazepines (any anxiety disorder, agoraphobia, social phobia) and pregabalin (any anxiety disorder, GAD, panic disorder) to be associated with comorbid anxiety disorders. Our findings suggest that the various anxiety disorders subtypes display divergent clinical characteristics and are associated with different variables. Especially comorbid GAD appears to be characterized by high symptom severity and poor treatment response.

25 Article Efficacy of orally administered Silexan in patients with anxiety-related restlessness and disturbed sleep--A randomized, placebo-controlled trial. 2015

Kasper, Siegfried / Anghelescu, Ion / Dienel, Angelika. ·Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: sci-biolpsy@meduniwien.ac.at. · Privat-Nerven-Klinik Dr. med. Kurt Fontheim, Liebenburg, Germany. · Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany. ·Eur Neuropsychopharmacol · Pubmed #26293583.

ABSTRACT: The anxiolytic effect of Silexan, a patented active substance with an essential oil produced from Lavandula angustifolia flowers, was investigated in patients with anxiety-related restlessness and disturbed sleep. 170 out-patients with a diagnosis of restlessness (ICD-10 R45.1), a Hamilton Anxiety Scale (HAMA) total score ≥18 points and ≥2 points for HAMA items 'Tension' and 'Insomnia' participated in this randomized, double-blind trial and received 80mg Silexan or placebo once daily for 10 weeks. Patients with clinically important other psychiatric or neurological disorders potentially interfering with the assessment of treatment efficacy were excluded. Outcome variables were the HAMA as well as the Pittsburgh Sleep Quality Index (PSQI), the Zung Self-rating Anxiety Scale, a State Check inventory and the Clinical Global Impressions questionnaire. In the Silexan group the HAMA total score decreased from an average of 25.5±6.0 points at baseline to 13.7±7.0 points at treatment end, compared to a decrease from 26.5±6.1 to 16.9±9.8 for placebo, corresponding to decreases of 12.0 and 9.3 points (marginal means), respectively (group difference: p=0.03, ANCOVA with factor treatment and baseline value as covariate). In all outcome measures the treatment effect of Silexan was more pronounced than with placebo. According to the HAMA, 48.8% and 33.3% of the patients were responders (Silexan, placebo; reduction ≥50%; p=0.04) and 31.4% and 22.6% achieved remission (HAMA<10; p=0.20). 33.7% (Silexan) and 35.7% (placebo) of the participants reported adverse events. The study confirms the calming and anxiolytic efficacy of Silexan.

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