OBJECTIVES: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.
Advisory Committees ; Aripiprazole ; Bipolar Disorder ; Buspirone ; Clozapine ; Drug Therapy ; Psychopharmacology ; Quetiapine Fumarate ; Thyroid Gland

AIM: Stress is recognized to precipitate anxiety and related psychological problems characterized by a wide range of biochemical and behavioral changes. The present study was carried out to investigate the protective effects of melatonin and buspirone, and their combination, against six hours immobilization stress-induced, anxiety-like behavioral and oxidative damage in mice. METHOD: Male Laca mice were pre-treated with melatonin (2.5, 5 mg·kg(-1)), buspirone (5, 10 mg·kg(-1)), and their combination for consecutive five days. On the 6(th) day, animals were immobilized for six hours, and thereafter various behavioral tests were performed followed by biochemical tests. RESULTS: Immobilization stress significantly impaired body weight, locomotor activity, and caused anxiety-like behavior, along with increased oxidative damage. Pretreatment with melatonin and buspirone significantly improved the loss in body weight and locomotor activity, attenuated anxiety-like behavior (in both the mirror chamber and plus maze performance tasks), further restored the levels of brain total proteins, and caused antioxidant-like effects, as evidenced by reduced lipid peroxidation, nitrite concentration, and restoration of reduced glutathione and catalase activity, as compared to control animals. In addition, combination of melatonin (2.5, 5 mg·kg(-1)) with buspirone (5 mg·kg(-1)) significantly potentiated their protective effects, as compared to their effects individually. CONCLUSION The present study suggests that melatonin potentiates the beneficial effect of buspirone against immobilization stress-induced, anxiety-like behavioral and oxidative damage in mice possibly by involving a serotonergic mechanism.
Animals ; Anti-Anxiety Agents ; pharmacology ; therapeutic use ; Antioxidants ; pharmacology ; therapeutic use ; Anxiety ; drug therapy ; Behavior, Animal ; drug effects ; Buspirone ; pharmacology ; therapeutic use ; Immobilization ; psychology ; Male ; Melatonin ; pharmacology ; therapeutic use ; Mice, Inbred Strains ; Oxidative Stress ; drug effects ; Stress, Psychological ; drug therapy

OBJECTIVES: This study was performed to investigate the consensus about medication algorithms, including long-term medication treatment strategies, in the treatment of generalized anxiety disorder (GAD). METHODS: The executive committee of the Korean Medication Algorithm Project for GAD developed questionnaires about the psychopharmacologic treatment strategies for patients with GAD. Fifty-five (65%) of 84 experts of a reviewing committee answered the questionnaires. The consensus of expert opinion was classified into three categories, and the treatments of choice were selected by use of 95% confidence intervals and chi-square-tests. RESULTS: The consensus on the first-line treatment strategy for GAD was as follows. Step 1 is the use of the one of a selective serotonin reuptake inhibitor (SSRI), a serotonin and noradrenaline reuptake inhibitor (SNRI) and buspirone for at least four to six weeks. Step 2 is to switch from a SSRI to a SNRI or buspirone or vice versa. Step 3 is to augment medication with an atypical antipsychotic or add a benzodiazepine or antihistamine. Step 4 is to switch to another combination, which includes a SSRI, a SNRI, mirtazapine or a tricyclic antidepressant Step 6 is to review the diagnosis, and 'benzodiazepines including clonazepam and alprazolam can be combined with another drug even from the initial period'. In terms of long-term medication treatment, the consensus first-line tr-eatment strategy involved the use of venlafaxine XR, escitalopram, fluoxetine, paroxetine CR, sertraline and buspirone. CONCLUSION: This study provided information about the consensus among Korean experts regarding medication algorithms, including long-term medication treatment strategies, in the treatment of GAD.
Alprazolam ; Anxiety ; Anxiety Disorders ; Benzodiazepines ; Buspirone ; Citalopram ; Clonazepam ; Consensus ; Cyclohexanols ; Expert Testimony ; Fluoxetine ; Humans ; Mianserin ; Norepinephrine ; Paroxetine ; Psychopharmacology ; Surveys and Questionnaires ; Serotonin ; Sertraline ; Venlafaxine Hydrochloride

Anxiety disorders are common psychiatric illnesses in the elderly. However, anxiety disorders in older people have not drawn much attention from researchers and clinicians alike, compared with late-life depression or dementia. The author searched for articles published from 1986 to 2006 using the key words including "anxiety", "elderly", "aged", and "pharmacological" therapy in the MEDLINE, PsychINFO, and KMbase in order to clarify effective pharmacological therapy in the elderly with anxiety disorders. Well designed studies for pharmacologic intervention in late-life anxiety disorders were rarely found. Nonetheless, studies on young adults demonstrated a number of pharmacological treatment options that can be applied to these patients. Pharmacologic treatments for the elderly include therapies using antideprssants, especially SSRI or SNRI, buspirone, or benzodiazepines. The latter requires special caution in the administration in the elderly because it can lead to adverse events. Therefore, well designed clinical trials are further needed to obtain optimal pharmacological intervention for the elderly with anxiety disorders.
Aged ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Dementia ; Depression ; Drug Therapy* ; Humans ; Young Adult

It was not above two or three decades from the changes began that regarding nicotine dependence as a kind of addictive disorder and a therapeutic target. Despite the short period of history, lots of medications were developed and showing significant clinical outcomes. In this review, we introduce the both of medications available at this time and in the status of developing for nicotine dependence. The clinical efficacies, practical ways of prescription, and common adverse events of the medications currently available are described through the survey of literatures. The novel medications in the process of developing are arranged by the proposed mechanism of action and summarized the phases of clinical trials at present. Among the diverse pharmacological tools now available, nicotine replacement and bupropion could be the first-line recommendation drugs and nortriptyline and clonidine could be the second-line recommendation drugs. Other medications like several antidepressants (e.g., moclobemide), buspirone, and naltrexone may be helpful in some specific population. Most of medications currently available have uncertainties in the aspects of their mechanisms of action except nicotine replacement materials; however, medications in developing have clearer neurobiological basis in their applications. Therefore, we can expect higher treatment outcomes by new products. Additionally, introduction of nicotine vaccines for high-risk group is drawing near. It could be possible for the individualizing for strategies of smoking cessation according to the patients' specific situation in a future.
Antidepressive Agents ; Bupropion ; Buspirone ; Clonidine ; Naltrexone ; Nicotine* ; Nortriptyline ; Prescriptions ; Smoking Cessation ; Tobacco Use Disorder* ; Vaccines

Generalized anxiety disorder (GAD) is highly prevalent psychiatric disorder in primary care population and is a source of major morbidity. However, the underawareness and undertreatment of GAD, which is due to insufficient knowledge about the disorder, often hinder the proper management of this chronic condition. Other characteristic features such as chronic course of GAD, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria should be fully discussed. First of all, proper and accurate diagnosis is crucial for an appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD and counseling about treatment alternatives and coping strategies is an important first step. The most effective treatment of GAD is combined psychotherapeutic and pharmacotherapeutic approach. The major psychotherapeutic approaches to GAD are cognitive-behavioral therapy with relaxation techniques. Pharmacological treatment for GAD includes benzodiazepine, buspirone, and antidepressants. In this review, these combined treatment at the view point of primary practitioners was described.
Antidepressive Agents ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Comorbidity ; Counseling ; Depressive Disorder ; Diagnosis* ; Education ; Primary Health Care ; Relaxation Therapy

Generalized anxiety disorder (GAD), that has been introduced into psychiatric nosology in DSM-III, is characterized by chronic worry that may persist for many years. Pharmacological treatment for GAD includes benzodiazepines, buspirone, and antidepressants. Benzodiazepine have commonly been used for treatment of acute anxiety disorders, but they are not ideal in the treatment of chronic generalized anxiety disorder (GAD). Buspirone appears to exert benefit primarily on psychic symptoms of anxiety, but the effect of buspirone is slower in onset, taking at least 2 weeks to become evident. Recently, new antidepressants has opened up a new area of investigation into pharmacotherapy of GAD, with a growing body of evidence supporting the role of therapies such as paroxetine and venlafaxine extended release. At present, some selective serotonin reuptake inhibitors such as paroxetine and venlafaxine are recommended for the best evidence-based approach in the long-term treatment of GAD.
Antidepressive Agents ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy* ; Paroxetine ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

Generalized anxiety disorder (GAD), that has been introduced into psychiatric nosology in DSM-III, is characterized by chronic worry that may persist for many years. Pharmacological treatment for GAD includes benzodiazepines, buspirone, and antidepressants. Benzodiazepine have commonly been used for treatment of acute anxiety disorders, but they are not ideal in the treatment of chronic generalized anxiety disorder (GAD). Buspirone appears to exert benefit primarily on psychic symptoms of anxiety, but the effect of buspirone is slower in onset, taking at least 2 weeks to become evident. Recently, new antidepressants has opened up a new area of investigation into pharmacotherapy of GAD, with a growing body of evidence supporting the role of therapies such as paroxetine and venlafaxine extended release. At present, some selective serotonin reuptake inhibitors such as paroxetine and venlafaxine are recommended for the best evidence-based approach in the long-term treatment of GAD.
Antidepressive Agents ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy* ; Paroxetine ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

BACKGROUND: Migraine is commonly associated with anxiety disorder. However, whether anxiolytic medicine or changes in anxiety levels affect the migraine attack is unclear. Buspirone, the agonist for 5-HT1A receptor, is effective in treating generalized anxiety disorder. In this study, we attempted to test the efficacy of buspirone for migraine combined with anxiety disorder. METHODS: 111 outpatients aged 20 to 70 years (mean, 46.4; SD, 12.8), were analyzed. The diagnosis of migraine was made according to the HIS (International Headache Society) criteria, and the level of anxiety was rated by the Hamiton Anxiety Rating Scale (HAM-A). The migraineurs were randomly assigned to treatment with either buspirone (15 mg/day) or placebo for 6 weeks. The efficacy variables included changes in headache frequency, headache intensity, Headache Index, Headache Management Self-Efficacy Scale (HMSE), Headache Disability Inventory (HDI), and the Hamilton Anxiety Rating Scale (HAM-A). The correlation between headache improvement and the anxiolytic effect were analyzed. RESULTS: Headache frequency showed a 43.3% reduction (from 6.7/2 weeks to 3.8/2 weeks) in the buspirone-treated group, whereas a 10.3% reduction (from 6.8 to 6.1/2 weeks) in the placebo group. The Headache Index, HDI, and HAM-A were also significantly lowered in buspirone-treated patients than in placebo-treated patients. However, the headache intensity or the HMSE score were not changed. Correlation analysis between the change of Headache Index and that of HAM-A revealed no significant association. CONCLUSIONS: Buspirone is an effective prophylactic agent in migraine combined with anxiety disorder. This prophylactic effect is not secondary to the anxiolytic effect. This suggests that the agonistic action for 5-HT1A is primarily effective in migraine prophylaxis.
Anti-Anxiety Agents ; Anxiety Disorders ; Anxiety* ; Buspirone* ; Diagnosis ; Headache ; Humans ; Migraine Disorders ; Outpatients ; Receptor, Serotonin, 5-HT1A

To provide a recent knowledge about pharmacological treatment of anxiety disorders in elderly, the author reviewed the articles and books for the treatment of elderly anxiety patients. Anxiety is the one of the most prevalent psychiatric symptoms in the elderly. Many psychological and physical causes including used drugs can induce the anxiety symptoms in elderly. However, it is often unrecognized and inadequately treated. The pharcokinetics and pharmacodynamic changes, con-comittent illnesses, compliance problems, and increased sensitivity to drugs in elderly have to be considered. Various pharmacological treatments (e.g benzodiazepines, buspirone, antidepressnats, beta-blockers, antihistamines, neuroleptics)were reported as having therapeutic effects for the treatment of geriatric anxiety disorders patients. They have their own advantages and disadvantages. However, anxiety in elderly have received little focus to date. The study results often depend on the studies from adult samples. A comprehensive, flexible, integrated, and specific treatment approaches should be applied to elderly anxious patients. The more systematized studies are needed to broaden the knowledge of the pharmacological treatment of anxiety disorders in the elderly.
Adult ; Aged* ; Anxiety ; Anxiety Disorders ; Benzodiazepines ; Buspirone ; Compliance ; Drug Therapy* ; Histamine Antagonists ; Humans