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The treatment of anxiety disorders: a legacy of William Sargant*

Published online by Cambridge University Press:  16 April 2020

MG Gelder*
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom
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Summary

In 1962 William Sargant and his colleagues described the therapeutic value of phenelzine, a monoamine oxidase inhibitor (MAOI), in chronic anxiety disorders and in the same year Klein and Fink reported the treatment of similar conditions with imipramine, a tricyclic antidepressant. Subsequent research has confirmed these findings and demonstrated the range of similar drugs that are effective in anxiety disorders. At the time of these original observations about the drug treatment of anxiety, there were no psychological treatments of proven value but in the intervening years much progress has been made in developing behavioural and cognitive procedures. The progress in determining the mode of action of these pharmacological and psychological treatments is reviewed and the implications of the findings are considered in relation to research into the causes of the anxiety disorders and to the treatment of patients.

Type
Original article
Copyright
Copyright © European Psychiatric Association 1997

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References

Andersch, SRosenberg, NKKullingsjo, HOttosson, J-OBech, PBruunberg, REfficacy safety of alprazolam imipra-mine and placebo in treating panic disorder. A Scandinavian multicenter study Acta Psychiatr Scand 365(suppl) 1991 1827CrossRefGoogle ScholarPubMed
Angst, JDobler-Mikola, ABinder, JThe Zurich Study: a prospective epidemiological study of depressive neurotic and psychosomatic syndromes Eur Arch Psychiatry Neurol Sci 234 1984 1320CrossRefGoogle ScholarPubMed
Arntz, Avan den Hout, MPsychological treatments of panic disorder without agoraphobia: cognitive therapy versus applied relaxation Behav Res Ther 34 1996 113121CrossRefGoogle ScholarPubMed
Beaudry, PFontaine, DChouinard, G, et al.Bromazepam, another high potency benzodiazepine for panic attacks Am J Psychiatry 141 1984 464465Google ScholarPubMed
Beck, ATLaude, RBohnerational components of anxiety neurosis Arch Gen Psychiatry 31 1974 319325CrossRefGoogle ScholarPubMed
Beck, ATSokol, LClark, DABerchick, BWright, FFocused cognitive therapy for panic disorder: a crossover design and one year follow-up Am J Psychiatry 147 1992 778783Google Scholar
Black, DWWesner, RBowers, WGabel, JA comparison of fluvoxamine, cognitive therapy and placebo in the treatment of panic disorder Arch Gen Psychiatry 50 1993 4450CrossRefGoogle ScholarPubMed
Bradwejn, JKoszycki, DCouetoux du Tertre, Avan Megen, MDden Boer, JWestenberg, HAnnable, LThe panicogenic effects of choleocystokinin tetrapeptide are antagonized by L-365,260, a central choleocystokinin receptor antagonist, in patients with panic disorder Arch Gen Psychiatry 51 1994 486493CrossRefGoogle Scholar
Butler, GFennell, MJVRobson, PGelder, MGComparison of behaviour therapy and cognitive behaviour therapy in the treatment of generalized anxiety disorder 7 Consult Clin Psychol 59 1991 167175CrossRefGoogle Scholar
Cassano, GBPetracca, APergugi, G, et al.Clomipramine for panic disorder: I The first 10 weeks of a long-term comparison with imipramine J Affect Disord 14 1988 123127CrossRefGoogle ScholarPubMed
Charney, DSHeninger, GRBreier, ANoradrenergic function in panic anxiety Arch Gen Psychiatry 41 1984 751783CrossRefGoogle ScholarPubMed
Charney, DSWoods, SWGoodman, WK, et al.Drug treatment of panic disorder: the comparative efficacy of imipramine, alprazolam and trazodone J Clin Psychiatry 47 1986 580586Google ScholarPubMed
Charney, DSWoods, SWBenzodiazepine treatment of panic disorder: a comparison of alprazolam and lorazepam J Clin Psychiatry 50 1989 418423Google ScholarPubMed
Clark, DMA cognitive approach to panic Behav Res Ther 23 1986 585600Google Scholar
Clark, DMSalkovskis, PMHackmann, AMiddleton, HAnas-tasiades, PGelder, MGA comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder Br J Psychiatry 164 1994 759769CrossRefGoogle ScholarPubMed
Clark, DMWells, AA cognitive model of social phobia In: Heimberg, RLiebowitz, MHope, DASchneier, FR eds.Social phobia: diagnosis, assessment and treatment 1995 Guilford Press New YorkGoogle Scholar
Cross-National Collaborative Panic Study Drug treatment of panic disorder: comparative efficacy of alprazolam, imipramine, and placebo Br J Psychiatry 160 1992 191202CrossRefGoogle Scholar
Deakin, JWGraeff, Psychology, 5-HT and mechanisms of defence J Psychopharmacol 5 1991 305315CrossRefGoogle Scholar
den Boer, JAWestenberg, HGMEffects of a serotonin uptake inhibitor in panic disorder: a double blind comparative study with fluvoxamine and maprotiline Int J Clin Psycho-pharmacol 3 1988 5974CrossRefGoogle ScholarPubMed
Dunner, DLIshiki, DAvery, DH, et al.Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study J Clin Psychiatry 47 1986 458460Google ScholarPubMed
Durham, RMurphy, TAllan, TRichard, KTreliving, LRCognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder Br J Psychiatry 165 1994 315323CrossRefGoogle Scholar
Durham, RCTurvey, AACognitive therapy vs behaviour therapy in the treatment of chronic generalized anxiety Behav Res Ther 25 1987 229334CrossRefGoogle Scholar
Fahy, TJO'Rourke, DBrophy, JSchazmann, WSciascia, SThe Galway study of panic disorder.I Clomipramine and lofepramine in DSM III-R panic disorder: a placebo con-trolled trial J Affect Disord 25 1992 6376CrossRefGoogle Scholar
Fyer, AJMannuzza, SChapman, TFMartin, LYKlein, DFSpecificity in familial aggregation of phobic disorders Arch Gen Psychiatry 52 1995 564573CrossRefGoogle ScholarPubMed
Gelernter, CSUhde, TWCimbolic, PArnkoff, DBVittone, BJTancer, MEBartko, JJCognitive-behavioural and pharmacological treatment of social phobia Arch Gen Psychiatry 48 1991 938945CrossRefGoogle Scholar
Gentil, VLotufo-Neto, FAndrade, LCordas, TBernik, MRamos, R, et al.Clomipramine a better reference drug for panic/agoraphobia. I Effectiveness comparison with imipramine J Psychopharmacol 7 1993 316324CrossRefGoogle ScholarPubMed
Gorman, JMAskanazi, JLiebowitz, MRFyer, AJStein, JKinney, JMKlein, DFResponse to hyperventilation in a group of patients with panic disorder Am J Psychiatry 141 1984 857861Google Scholar
Gorman, JMLiebowitz, MRFyer, AJGoetz, DCampeas, RBFyer, MR, et al.An open trial of fluoxetine in the treatment of panic attacks J Clin Psychopharmacol 7 1987 329332CrossRefGoogle ScholarPubMed
Hoehn-Saric, RMcLeod, DRZimmerlin, WDDifferential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms J Clin Psychiatry 49 1988 293301Google ScholarPubMed
Kahn, RJMcNair, DMLipman, RSCovi, LRickeis, KDowning, R, et al.Imipramine and chlordiazepoxide in depressive and anxiety disorders: II efficacy in anxious outpatients Arch Gen Psychiatry 43 1986 7985CrossRefGoogle ScholarPubMed
Katzelnick, DJKobak, KAGreist, JHJefferson, JWMantle, JMSerlin, RCSertraline for social phobia: a double blind placebo controlled crossover study Am J Psychiatry 152 1995 13681371Google ScholarPubMed
Kendler, KNeale, MKessler, R, et al.Generalized anxiety disorder in women: a population based twin study Arch Gen Psychiatry 49 1992 267272CrossRefGoogle ScholarPubMed
Klein, DFFink, MPsychiatric reaction patterns to imipramine Am J Psychiatry 119 1962 432438CrossRefGoogle ScholarPubMed
Klerman, GLOverview of the cross-national collaborative panic study Arch Gen Psychiatry 45 1988 407412CrossRefGoogle ScholarPubMed
Liebowitz, MRFyer, AJGorman, JMDillon, DDavies, SStein, JM, et al.Specificity of lactate infusions in social phobia versus panic disorders Am J Psychiatry 142 1985 947950Google ScholarPubMed
Liebowitz, MRSchneier, FCampeas, RHollander, EHatterer, JFyer, A, et al.Phenelzine vs atenolol in social phobia.A placebo controlled comparison Arch Gen Psychiatry 49 1992 290300CrossRefGoogle ScholarPubMed
Margraf, JSchneider, SOutcome and active ingredients of cognitive behavioural treatments for panic disorder Paper present at the Annual Conference of Association for Advancement of Behaviour Therapy New York 1991Google Scholar
Marks, IMGelder, MGDifferent ages of onset of varieties of phobia Br J Psychiatry 123 1966 218221Google ScholarPubMed
Noyes, R JrAnderson, DJClancy, J, et al.Diazepam and propa-nolol in panic disorder and agoraphobia Arch Gen Psychiatry 41 1984 287292CrossRefGoogle ScholarPubMed
Nutt, DJGlue, PLawson, CWilson, SFlumazenil provocation of panic attacks Arch Gen Psychiatry 47 1990 917925CrossRefGoogle ScholarPubMed
Ottaviani, RBeck, ATCognitive aspects of panic disorders J Anxiety Disord 1 1987 1528CrossRefGoogle Scholar
Öst, LGWestling, BApplied relaxation vs cognitive therapy in the treatment of panic disorder Behav Res Ther 33 1995 145158CrossRefGoogle ScholarPubMed
Pitts, FNMcClure, JNLactate metabolism in anxiety neurosis New Engl J Med 277 1967 13281336CrossRefGoogle ScholarPubMed
Power, KGJerrom, DWASimpson, RJMitchell, MJSwanson, VA controlled comparison of cognitive-behaviour therapy, diazepam and placebo in the management of generalised anxiety disorder Behav Psychother 17 1989 114CrossRefGoogle Scholar
Power, KGSimpson, RJSwanson, VWallace, LAFeistner, ATCSharp, DA controlled comparison of cognitive behaviour therapy, diazepam, and placebo, alone and in combination for the treatment of generalized anxiety disorder J Anxiety Disord 4 1990 267293CrossRefGoogle Scholar
Rapee, RMattick, RMurrell, ECognitive mediation in the affective component of spontaneous panic attacks J Behav Ther Exp Psychiatry 17 1986 245253CrossRefGoogle ScholarPubMed
Rickels, KDowning, RSchweizer, EHassman, HAntidepressants for the treatment of generalized anxiety disorder Arch Gen Psychiatry 50 1993 884895CrossRefGoogle ScholarPubMed
Sargant, WDally, PTreatment of anxiety states by antidepress-ant drugs Br Med J 1 1962 69CrossRefGoogle ScholarPubMed
Sargant, WAim and method in treatment: twenty years of British and American psychiatry J Ment Sci 103 1957 699709CrossRefGoogle ScholarPubMed
Schweizer, ERickels, KWeiss, SZavodnick, SMaintenance drug treatment of panic disorder Arch Gen Psychiatry 50 1993 5160CrossRefGoogle ScholarPubMed
Sheehan, DVBallenger, JJacobsen, GTreatment of endogenous anxiety with phobic, hysterical and hypochondriacal symptoms Arch Gen Psychiatry 37 1980 5159CrossRefGoogle ScholarPubMed
Tesar, GERosenbaum, JFPollack, MH, et al.Clonazepam vs alprazolam in the treatment of panic disorder: interim analysis of data from a prospective double-blind placebo-controlled trial J Clin Psychiatry 48suppl 111984 1619Google Scholar
Van der Molen, GMvan den Hout, MAVroemen, JLousberg, HGriez, ECognitive determinants of lactate-induced anxiety Behav Res Ther 24 1986 677680CrossRefGoogle ScholarPubMed
van, Vliet IMden Boer, JAWestenberg, HGMPsychopharma-cological treatment of social phobia: a double blind placebo controlled study with fluvoxamine Psychopharmacology 115 1994 128134Google Scholar
Versiani, MNardi, AEMundim, FDAlves, ABLiebowitz, MRAmrein, RPharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine Br J Psychiatry 161 1992 353360CrossRefGoogle ScholarPubMed
Woods, SWCharney, DSGoodman, WKHeninger, GRCarbon dioxide-induced anxiety Arch Gen Psychiatry 45 1988 4352CrossRefGoogle ScholarPubMed
Zitrin, CMKlein, DFWoerner, MG, et al.Treatment of phobias I: Comparison of imipramine hydrochloride and placebo Arch Gen Psychiatry 40 1983 125138CrossRefGoogle ScholarPubMed
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