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Sexual Medicine Reviews Apr 2020Sexual performance anxiety (SPA) is one of the most prevalent sexual complaints; yet, no diagnosis is recognized for either gender. Thus, research into treatment has... (Review)
Review
INTRODUCTION
Sexual performance anxiety (SPA) is one of the most prevalent sexual complaints; yet, no diagnosis is recognized for either gender. Thus, research into treatment has been minimal.
AIM
Review the prevalence of SPA and its relation to sexual dysfunctions and anxiety disorders. Compare SPA to (non-sexual) performance anxiety and social anxiety (PA/SA). Apply pharmacologic principles to the known properties of drugs and phytotherapies to hypothesize treatments for SPA.
METHODS
Review SPA and PA/SA through PubMed searches for relevant literature from 2000 to 2018.
MAIN OUTCOME MEASURE
Prevalence was estimated using population-representative surveys. For treatment results, controlled clinical trial results were prioritized over open-label trial results.
RESULTS
SPA affects 9-25% of men and contributes to premature ejaculation and psychogenic erectile dysfunction (ED). SPA affects 6-16% of women and severely inhibits sexual desire. Cognitive behavior therapy and mindfulness meditation training have been proven effective for PA/SA and are recommended for SPA, but controlled studies are lacking. Phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation, both of which include SPA as a major element. Drugs proven for PA/SA have adverse sexual and sedative effects, but serotonergic anxiolytics with prosexual effects (buspirone ± testosterone, trazodone ± bupropion) may have potential, and sage, passionflower, l-theanine, and bitter orange are anxiolytic. Nitric oxide boosters (l-citrulline, l-arginine, Panax ginseng) have the potential for increasing genital tumescence and lubrication, and plant-based alpha-adrenergic antagonists may aid sexual arousal (yohimbine/yohimbe, Citrus aurantium/p-synephrine).
CONCLUSION
SPA causes or maintains most common sexual dysfunction. No treatments are well proven, although cognitive behavior therapy, mindfulness meditation training, and serotonergic anxiolytics (buspirone, trazodone, gepirone) have potential, and phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation. Several phytotherapies also appear to have potential. Pyke RE. Sexual Performance Anxiety. J Sex Med 2020;8:183-190.
Topics: Anti-Anxiety Agents; Cognitive Behavioral Therapy; Female; Humans; Male; Performance Anxiety; Prevalence; Sexual Dysfunctions, Psychological
PubMed: 31447414
DOI: 10.1016/j.sxmr.2019.07.001 -
Cognitive Behaviour Therapy Jan 2020The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and... (Meta-Analysis)
Meta-Analysis
The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (= 0.76) and medication showed a small effect size (= 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (= 0.64) as did medications (= 0.59). Younger age was associated with a larger effect size for psychotherapy (< 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Humans; Outcome and Process Assessment, Health Care; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 30760112
DOI: 10.1080/16506073.2018.1560358 -
Ugeskrift For Laeger Jan 2020
Topics: Anti-Anxiety Agents; Benzodiazepines; Depression; Depressive Disorder; Humans
PubMed: 31928618
DOI: No ID Found -
Phytomedicine : International Journal... Jul 2023Suanzaoren decoction (SZRD) is a classical traditional Chinese prescription. It is widely used to treat mental disorders, including insomnia, anxiety, and depression, in...
Screening the effective components of Suanzaoren decoction on the treatment of chronic restraint stress induced anxiety-like mice by integrated chinmedomics and network pharmacology.
BACKGROUND
Suanzaoren decoction (SZRD) is a classical traditional Chinese prescription. It is widely used to treat mental disorders, including insomnia, anxiety, and depression, in China and other Asian countries. However, the effective components and mechanisms underlying SZRD remained unclear.
PURPOSE
We aimed to develop a new strategy to discover the effects and potential mechanisms of SZRD against anxiety and to further reveal the effective components of SZRD in treating anxiety.
STUDY DESIGN AND METHODS
First, the chronic restraint stress (CRS)-induced mouse model of anxiety was orally administered SZRD, and behavioral indicators and biochemical parameters were applied to assess efficacy. A chinmedomics strategy based on UHPLC-Q-TOF-MS technology and network pharmacology were then used to screen and explore potentially effective components and therapeutic mechanisms. Finally, molecular docking was applied to further confirm the effective components of SZRD, and a multivariate network for anxiolytic effects was constructed.
RESULTS
SZRD exerted anxiolytic effects by increasing the percentage of entries into open arms and the time spent in open arms; improving hippocampal 5-HT, GABA, and NE levels; and increasing serum corticosterone (CORT) and corticotropin-releasing hormone (CRH) levels caused by CRS challenge. Beside, SZRD exerted a sedative effect by decreasing sleep time and prolonging sleep latency with no muscle relaxation effect in CRS mice. A total of 110 components were identified in SZRD, 20 of which were absorbed in the blood. Twenty-one serum biomarkers involved in arachidonic acid, tryptophan, sphingolipid, and linoleic acid metabolism were identified after SZRD intervention. Finally, a multivariate network including prescription-effective components-targets-pathway of SZRD treating anxiety, including 11 effective components, 4 targets and 2 pathway was constructed.
CONCLUSION
The current study demonstrated that integrating chinmedomics and network pharmacology was a powerful approach to investigating the effective components and therapeutic mechanisms of SZRD and provided a solid basis for the quality marker (Q-marker) of SZRD.
Topics: Mice; Animals; Anti-Anxiety Agents; Network Pharmacology; Molecular Docking Simulation; Drugs, Chinese Herbal; Anxiety
PubMed: 37156059
DOI: 10.1016/j.phymed.2023.154853 -
Lancet (London, England) Oct 2021Agitation is common in people with dementia and negatively affects the quality of life of both people with dementia and carers. Non-drug patient-centred care is the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Agitation is common in people with dementia and negatively affects the quality of life of both people with dementia and carers. Non-drug patient-centred care is the first-line treatment, but there is a need for other treatment when this care is not effective. Current evidence is sparse on safer and effective alternatives to antipsychotics. We assessed the efficacy and safety of mirtazapine, an antidepressant prescribed for agitation in dementia.
METHODS
This parallel-group, double-blind, placebo-controlled trial-the Study of Mirtazapine for Agitated Behaviours in Dementia trial (SYMBAD)-was done in 26 UK centres. Participants had probable or possible Alzheimer's disease, agitation unresponsive to non-drug treatment, and a Cohen-Mansfield Agitation Inventory (CMAI) score of 45 or more. They were randomly assigned (1:1) to receive either mirtazapine (titrated to 45 mg) or placebo. The primary outcome was reduction in CMAI score at 12 weeks. This trial is registered with ClinicalTrials.gov, NCT03031184, and ISRCTN17411897.
FINDINGS
Between Jan 26, 2017, and March 6, 2020, 204 participants were recruited and randomised. Mean CMAI scores at 12 weeks were not significantly different between participants receiving mirtazapine and participants receiving placebo (adjusted mean difference -1·74, 95% CI -7·17 to 3·69; p=0·53). The number of controls with adverse events (65 [64%] of 102 controls) was similar to that in the mirtazapine group (67 [66%] of 102 participants receiving mirtazapine). However, there were more deaths in the mirtazapine group (n=7) by week 16 than in the control group (n=1), with post-hoc analysis suggesting this difference was of marginal statistical significance (p=0·065).
INTERPRETATION
This trial found no benefit of mirtazapine compared with placebo, and we observed a potentially higher mortality with use of mirtazapine. The data from this study do not support using mirtazapine as a treatment for agitation in dementia.
FUNDING
UK National Institute for Health Research Health Technology Assessment Programme.
Topics: Aged, 80 and over; Anti-Anxiety Agents; Brief Psychiatric Rating Scale; Caregivers; Dementia; Double-Blind Method; Female; Humans; Male; Mirtazapine; Psychomotor Agitation; Quality of Life; United Kingdom
PubMed: 34688369
DOI: 10.1016/S0140-6736(21)01210-1 -
Molecules (Basel, Switzerland) Apr 2022Aromas have a powerful influence in our everyday life and are known to exhibit an array of pharmacological properties, including anxiolytic, anti-stress, relaxing, and... (Review)
Review
Aromas have a powerful influence in our everyday life and are known to exhibit an array of pharmacological properties, including anxiolytic, anti-stress, relaxing, and sedative effects. Numerous animal and human studies support the use of aromas and their constituents to reduce anxiety-related symptoms and/or behaviours. Although the exact mechanism of how these aromas exert their anxiolytic effects is not fully understood, the GABAergic system is thought to be primarily involved. The fragrance emitted from a number of plant essential oils has shown promise in recent studies in modulating GABAergic neurotransmission, with GABA receptors being the primary therapeutic target. This review will explore the anxiolytic and sedative properties of aromas found in common beverages, such as coffee, tea, and whisky as well aromas found in food, spices, volatile organic compounds, and popular botanicals and their constituents. In doing so, this review will focus on these aromas and their influence on the GABAergic system and provide greater insight into viable anxiety treatment options.
Topics: Animals; Anti-Anxiety Agents; Anxiety; Hypnotics and Sedatives; Odorants; Oils, Volatile; Plant Oils; Receptors, GABA-A
PubMed: 35458615
DOI: 10.3390/molecules27082414 -
Psychiatric Services (Washington, D.C.) Jan 2023The number of benzodiazepine (BZD) prescriptions has substantially increased over the past decade, leading to a parallel rise in rates of misuse and overdose. These...
The number of benzodiazepine (BZD) prescriptions has substantially increased over the past decade, leading to a parallel rise in rates of misuse and overdose. These increases have prompted the U.S. Food and Drug Administration to update its "boxed warning" and have caused organizations to revisit prescribing guidelines. Concurrently, strong evidence from clinical trials supports the anxiolytic efficacy of BZDs. Although antidepressants and psychotherapy remain preferred treatments for chronic anxiety, BZDs remain helpful in treating acute or severe and persistent anxiety that does not respond to first-line therapy. Provider and patient education, coupled with prescribing surveillance, may be preferable to an overly stringent regulatory approach to guiding BZD use.
Topics: Humans; Benzodiazepines; Drug Overdose; Anti-Anxiety Agents; Anxiety Disorders; Walking
PubMed: 36321316
DOI: 10.1176/appi.ps.202100671 -
Biomedicine & Pharmacotherapy =... Dec 2023Protein posttranslational modification regulates synaptic protein stability, sorting and trafficking, and is involved in emotional disorders. Yet the molecular...
Protein posttranslational modification regulates synaptic protein stability, sorting and trafficking, and is involved in emotional disorders. Yet the molecular mechanisms regulating emotional disorders remain unelucidated. Here we report unknown roles of protein palmitoylation/nitrosylation crosstalk in regulating anxiety-like behaviors in rats. According to the percentages of open arm duration in the elevated plus maze test, the rats were divided into high-, intermediate- and low-anxiety groups. The palmitoylation and nitrosylation levels were detected by acyl-biotin exchange assay, and we found low palmitoylation and high nitrosylation levels in the basolateral amygdala (BLA) of high-anxiety rats. Furthermore, we observed that 2-bromopalmitate (2-BP), a palmitoylation inhibitor, induced anxiety-like behaviors, accompanied with decreased amplitude and frequency of mEPSCs and mIPSCs in the BLA. Additionally, we also found that inhibiting nNOS activity with 7-nitroindazole (7-NI) in the BLA caused anxiolytic effects and reduced the synaptic transmission. Interestingly, diazepam (DZP) rapidly elevated the protein palmitoylation level and attenuated the protein nitrosylation level in the BLA. Specifically, similar to DZP, the voluntary wheel running exerted DZP-like anxiolytic action, and induced high palmitoylation and low nitrosylation levels in the BLA. Lastly, blocking the protein palmitoylation with 2-BP induced an increase in protein nitrosylation level, and attenuating the nNOS activity by 7-NI elevated the protein palmitoylation level. Collectively, these results show a critical role of protein palmitoylation/nitrosylation crosstalk in orchestrating anxiety behavior in rats, and it may serve as a potential target for anxiolytic intervention.
Topics: Rats; Animals; Basolateral Nuclear Complex; Anti-Anxiety Agents; Lipoylation; Motor Activity; Anxiety; Diazepam
PubMed: 37948993
DOI: 10.1016/j.biopha.2023.115859 -
Acta Psychiatrica Scandinavica Nov 2023
Topics: Humans; Aged; Benzodiazepines; Anti-Anxiety Agents
PubMed: 37827997
DOI: 10.1111/acps.13619 -
Journal of Basic and Clinical... Jul 2023The vestibular system inhibits both HPA and SAM axis and contributes to the management of anxiety. Both direct and indirect pathways exist in the inhibition of the HPA... (Review)
Review
The vestibular system inhibits both HPA and SAM axis and contributes to the management of anxiety. Both direct and indirect pathways exist in the inhibition of the HPA and SAM axis. In this review article, the authors describe various pathways through which the vestibular system can regulate the HPA and SAM axis activity. Lastly, the authors highlight the need of starting translational research work in this field. Rocking is soothing and this is a universal fact that babies in the swing will calm down and sleep. These soothing effects of vestibular stimulation may be due to the inhibition of cortical and subcortical structures. Vestibular stimulation may be able to manage anxiety through its connections with multiple brain areas. There is a need to undertake translational research in this area to establish strong scientific evidence and recommend implementation of the vestibular stimulation in the management of anxiety.
Topics: Anti-Anxiety Agents; Cerebral Cortex; Brain; Anxiety
PubMed: 37070257
DOI: 10.1515/jbcpp-2023-0022