Cerebral blood flow changes after treatment of social phobia with the neurokinin-1 antagonist GR205171, citalopram, or placebo.

• BACKGROUND: Evidence is accumulating that pharmacological blockade of the substance P preferring neurokinin-1 (NK1) receptor reduces anxiety. This study compared the effects of an NK1 receptor antagonist, citalopram, and placebo on brain activity and anxiety symptoms in social phobia. METHODS: Thirty-six patients diagnosed with social phobia were treated for 6 weeks with the NK1 antagonist GR205171 (5 mg), citalopram (40 mg), or matching placebo under randomized double-blind conditions. GR205171 was administered for 4 weeks preceded by 2 weeks of placebo. Before and after treatment, regional cerebral blood flow (rCBF) during a stressful public speaking task was assessed using oxygen-15 positron emission tomography. Response rate was determined by the Clinical Global Impression Improvement Scale. RESULTS: Patients improved to a larger extent with the NK1 antagonist (41.7% responders) and citalopram (50% responders), compared with placebo (8.3% responders). Within- and between-group comparisons showed that symptom improvement was paralleled by a significantly reduced rCBF response to public speaking in the rhinal cortex, amygdala, and parahippocampal-hippocampal regions. The rCBF pattern was corroborated in follow-up analyses of responders and subjects showing large state anxiety reduction. CONCLUSIONS: Short-term administration of GR205171 and citalopram alleviated social anxiety. Neurokinin-1 antagonists may act like serotonin reuptake inhibitors by attenuating neural activity in a medial temporal lobe network.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Psykiatri (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Psychiatry (hsv//eng)

SAMHÄLLSVETENSKAP  -- Psykologi -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology -- Psychology (hsv//eng)

Nyckelord

Adult

Anxiety/*drug therapy/physiopathology

Cerebrovascular Circulation/*drug effects

Citalopram/*pharmacology/therapeutic use

Comparative Study

Double-Blind Method

Female

Humans

Male

Phobic Disorders/*drug therapy/physiopathology

Piperidines/*pharmacology/therapeutic use

Positron-Emission Tomography

Receptors; Neurokinin-1/antagonists & inhibitors

Research Support; Non-U.S. Gov't

Serotonin Uptake Inhibitors/*pharmacology/therapeutic use

Temporal Lobe/blood supply/radionuclide imaging

Tetrazoles/*pharmacology/therapeutic use

Publikations- och innehållstyp

vet (ämneskategori)

art (ämneskategori)