36,135 Relatively small switch studies have shown the benefit of treatment with a different agent with proven efficacy, for example venlafaxine143 or phenelzine.144 Augmentation strategies that may be considered include the use of buspirone,145 clonazepam,146 and combined pharmacological and psychological therapy.133,147 There has again been interest in the possibility that D-cycloserine may

be useful in enhancing CBT. An early proof-of -principle trial indicated that this agent was significantly more effective than placebo in enhancing CBT.148 Other targets for CBT augmentation have also been suggested,12 and this seems an exciting area for future investigation.149 As in the case of other anxiety disorders, there is Inhibitors,research,lifescience,medical significant scope for studies that incorporate genetic and imaging methods into pharmacotherapy studies,150,151 aiming ultimately at individualizing treatment approaches in SAD. Conclusion The glass of pharmacotherapy of Inhibitors,research,lifescience,medical anxiety disorders studies seems both half-full and half-empty. On the

one hand, there is a good number of randomized clinical trials of anxiety disorders; these have been extensively reviewed and meta-analyzed, and they include a particularly large and persuasive set of studies showing efficacy and relatively good tolerability of the SSRIs in the major anxiety disorders. Secondary analyses of such datasets have informed questions such as optimal definition of response and remission, Inhibitors,research,lifescience,medical optimal dose and duration, and comparative efficacy of different agents.7,36,152 Innovative questions, such as the use of pharmacotherapy for prophylactic purposes, have begun to be studied.42,108 Inhibitors,research,lifescience,medical On the other hand, a significant proportion of patients with anxiety disorders fail to be diagnosed and treated,1 or to respond to first-line agents, and there is a limited database of efficacy or effectiveness studies to guide treatment in such cases. Pharmacotherapy of children and adolescents, and of the elderly

with anxiety disorders are other areas where some recommendations can be made, but where much further work is needed.153,154 There is a significant Inhibitors,research,lifescience,medical research gap in that most studies have been undertaken at academic tertiary centers in high-income countries for registration purposes, while worldwide the vast majority of the clinical burden of anxiety disorders manifests Casein kinase 1 in low- and selleckchem middle-income countries in the community and in primary care. Fortunately, although much remains to be learned about the pathogenesis of the anxiety disorders, progress has been made, and such work has led to some of the first bedside neuroscience interventions ever to have emerged directly from the bench.127,155 Further such work should be encouraged; there is significant scope for merging new neuroscience methodologies, for example, imaging and gene expression156,157 with pharmacotherapy studies in order to help find new treatment targets, and in order to better personalize future treatment strategies.