The Management of Anxiety and Depressive Disorders: A Review

While anxiety and mild-moderate depression (the so-called neuroses) are the commonest mental disorders, they receive scant attention. They should be considered together, because they commonly occur together, are typically chronic, and respond to the same treatment. This review challenges traditional notions about the neuroses, by examining the reasons for their co-morbidity, the effectiveness of SSRIs in anxiety, and the biological basis of anxiety. From neuro-endocrine, psycho-immunology, genetic and clinical studies, anxiety and depression could denote manifestations of an underlying cause. Anxiety results from a dysregulation of homeostasis in the serotonin and noradrenergic systems, which SSRIs stabilize. Treatment guidelines recommend that SSRIs and SNRI should be first-line in the treatment of anxiety disorders, in combination with psychotherapy, with benzodiazepines used on short-term basis. Remission should be the goal of treatment. Outcome should include clinical, functional and disability assessments, graded in terms of response, remission and recovery. Perhaps the SSRIs and SNRI should be recognized as anti-neurotic. Mental disorders probably exist in a biological system with serotonin at the root of the neuroses, while dopamine sub-stands the psychoses.