Antidepressants as first-line agents in the current pharmacotherapy of anxiety disorders.

Anxiety disorders represent the most prevalent psychiatric disorders occurring in the general population, with a high degree of associated morbidity, functional impairment, and health care utilization. Each year, approximately 16 million people suffer from an anxiety disorder, while an additional 12 million report comorbidity of anxiety and at least one other psychiatric disorder (Kessler et al., 1994). Greenberg et al. (1999) estimated the 1990 annual cost of anxiety disorders in the United States to be approximately $42.3 billion, with roughly 88% (or $37.1 billion) being spent on psychiatric and nonpsychiatric medical treatment and prescription pharmaceutical costs. More than half of these costs were attributable to nonpsychiatric medical expenditures, raising the possibility that many patients go undiagnosed or misdiagnosed and consequently may receive inappropriate or inefficient treatment. This indicates that much can be done to increase awareness of the appropriate detection and treatment of anxiety disorders, and psychologists, particularly those in primary care and other nonpsychiatric settings, can be highly instrumental in improving quality of care and of life. Over the last decade, there has been a shift in the order of medications considered as first-line treatments for anxiety disorders. This transition was largely initiated by the introduction and consolidation of the selective serotonin reuptake inhibitors (SSRIs)—fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram—in the treatment of depression, and by the subsequent extension of these agents beyond depression to various anxiety disorders, such as obsessive-com pulsive disorder and panic disorder. These agents increase the amount of serotonin available in the neuronal synapse by blocking the reuptake pump that reabsorbs serotonin into the presynaptic neuron. Other new and atypical