PHARMACOTHERAPY OF ANXIETY DISORDERS: FROM PATHOGENESIS TO PERSONALIZED TREATMENT
DOI:
https://doi.org/10.11603/2312-0967.2025.3.15601Keywords:
anxiety disorders, war, stress, pharmacotherapy, SSRIs, SNRIs, etifoxine, neurosteroids, pharmacogenetics, personalized psychiatry, pharmacokineticsAbstract
The aim of the work is to summarize current evidence-based approaches to the pharmacotherapy of acute and chronic anxiety under wartime conditions, considering pathophysiological mechanisms, pharmacological characteristics, and potential drug interactions.Materials and Methods. An analytical review of contemporary clinical guidelines and standards (NICE, APA, CANMAT, and the State Expert Center of the Ministry of Health of Ukraine, 2021–2023) was conducted, along with systematic reviews, meta-analyses, and publications indexed in PubMed, Scopus, and Web of Science over the past decade.
Results and Discussion. The pathogenesis of anxiety disorders in the context of chronic stress involves dysregulation of serotonergic, noradrenergic, and GABAergic neurotransmission, hyperactivation of the hypothalamic-pituitary-adrenal axis, neuroinflammation, and epigenetic modifications. The main pharmacotherapeutic agents include SSRIs, SNRIs, benzodiazepines, pregabalin, and β-adrenergic blockers. Promising directions include the use of multimodal antidepressants (vortioxetine, agomelatine), neurosteroids (zuranolone, PRAX-114), and modulators of the GABA<sub>A</sub>- and TSPO-systems (etifoxine, GRX-917). Among alternative treatments, Silexan – a standardized lavender oil preparation – has demonstrated efficacy in mild and moderate anxiety with excellent tolerability. Key principles of safe pharmacotherapy include gradual dose titration, pharmacological audit, monitoring of potential interactions, and pharmacogenetic testing.
Conclusions. Optimization of anxiety treatment under wartime conditions requires a personalized, multidisciplinary approach that combines classical and innovative pharmacological strategies. Future research should focus on novel neurobiological targets (NMDA, GABA<sub>A</sub>, and TSPO systems) and the integration of digital biomarkers, pharmacogenetics, and artificial intelligence algorithms to monitor therapeutic efficacy and safety. Such an approach ensures rapid, safe, and sustained clinical effects, adaptable to wartime and post – war rehabilitation settings.
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