For over thirty years the benzodiazepines monopolised not only the
anxiolytic market but also clinical and animal research in anxiety.
Indeed many animal tests developed since the 1960s have been optimised
for the benzodiazepines and some programmes have even screened
candidates as potential anxiolytics on their benzodiazepine-like
side-effects rather than their anxiolytic activity. With the realisation
of the drawbacks of the benzodiazepines, namely their potential for
tolerance and dependency, there has been a renewed interest in
alternative anxiolytics both from existing drugs such as the tricyclic
and monoamine oxidase antidepressants and from newer agents such as
buspirone. In addition anxiety is no longer considered to be a unique
entity but rather an umbrella term for a series of specific anxiety
disorders such as panic disorder without or with agoraphobia,
generalised anxiety disorder (GAD), specific phobias, social phobias and
post-traumatic stress disorder (PTSD). These new clinical categories
have opened another dimension in the therapy of anxiety requiring the
optimisation of treatments for different syndromes. This book is a
critical review of today's anxiolytics and those that may become the
anxiolytics of tomorrow. What is clear is that currently there are few
clinically satisfactory alternatives to the benzodiazepines for the
treatment of acute anxiety. For chronic anxiety, it is generally agreed
that benzodi- azepines are not the treatment of first choice. The
tricyclic and monoamine oxidase antidepressants, the serotonin reuptake
inhibitors and buspirone offer better solutions for chronic anxiety but
they are still far from being ideal.
