Anxiety Disorder Clinical Research Trials
Dr. David Spiegel, director of clinical and medical programs at Boston University’s Center for Anxiety-Related Disorders, has been involved in trials monitoring more than 300 patients suffering from panic disorder. The results, published this summer in the New England Medical Journal, showed that the use of antidepressants and cognitive therapy work equally well, but that a combination of the two produced no curative leap.
The upshot is that people should go with one treatment or the other. The only proviso is that relapse rates were much higher among those treated with medication.
Spiegel says that anxiety disorders tend to run in families. Indeed, research on identical twins has shown that there is a genetic component to most anxiety disorders. But only 30 percent of cases are attributable to genetics.
“What accounts for the rest is a combination of psychological factors,” says Spiegel. “Some people are more stress-sensitive than others and will rush to the ER when they experience a racing heartbeat, when someone else might just surmise that they’d drunk too much coffee that day.”
More anxiety disorders in developed countries?
Spiegel does not share Ronald Kessler’s view that a more stressful and angst-ridden society begets more anxiety disorders, because no correlation has been found between the level of development and incidences of anxiety disorder in other countries.
“Genetically, there is little reason to believe that you would find a difference in developed and undeveloped countries, because the flight or fight system…arises in the most primitive part of the brain. In fact, it’s even found in snails,” says Spiegel.
“What differs are the levels of stress different cultures place on individuals and how much a society is willing to tolerate and share that stress,” he says. “In a culture where there are strong support networks, someone with an anxiety disorder may not be identified at all.”
“Modern American society is less tolerant,” says Spiegel, “and the consequences of not being able to perform at your peak are greater. Also, our support networks have been decimated by families moving far away from another; people are on their own more and more.”