Levetiracetam as adjunctive therapy for refractory anxiety disorders.
BACKGROUND
Anxiety disorders are the most prevalent psychiatric disorders as a group, and despite the effectiveness of currently available treatments for anxiety, many patients (40%-65%) remain symptomatic after initial intervention. Thus, there is a significant need for efficacious pharmacologic agents that are safe and well tolerated and lead patients to remission of symptoms. We present a retrospective analysis that assessed the efficacy and tolerability of adjunctive levetiracetam, a novel anticonvulsant agent, in the treatment of refractory anxiety.


METHODS
Forty patients with DSM-IV anxiety disorders, who were deemed partial responders or nonresponders to anxiolytic therapy, received adjunctive levetiracetam in a naturalistic fashion during the time period from January 2004 through December 2004. We conducted a retrospective chart review. The primary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Clinical Global Impressions-Improvement (CGI-I) scale. Mean change from baseline to endpoint was assessed using 2-tailed paired t tests.


RESULTS
Levetiracetam at a mean +/- SD dose of 1969 +/- 819 mg/day for a mean +/- SD time period of 9.3 +/- 5.1 weeks was generally well tolerated. Patients were markedly ill with a mean +/- SD baseline CGI-S score of 6.2 +/- 0.6. Patients improved significantly, with an endpoint CGI-S score of 4.2 +/- 1.8 (p < .001) and CGI-I score of 2.6 +/- 1.2. Adverse events were generally mild, and only 4 patients discontinued levetiracetam because of side effects.


CONCLUSIONS
These preliminary data suggest that levetiracetam may be an effective adjunctive treatment for patients with anxiety disorders who remain symptomatic despite initial anxiolytic therapy.
Anxiety Disorders Research Program, Cambridge Health Alliance, Cambridge, MA 02139, USA. gkinrys@challiance.org
Gustavo
G
Kinrys
John J
JJ
Worthington
Lisa
L
Wygant
Fernanda
F
Nery
Hannah
H
Reese
Mark H
MH
Pollack
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam