Levetiracetam as Adjunctive Therapy for Refractory Anxiety Disorders

Background: Anxiety disorders are the most prevalent psychiatric disorders as a group, and despite the effectiveness of currently available treatments for anxiety, many patients (40%-65%) remain symptomatic after initial intervention. Thus, there is a significant need for efficacious pharmacologic agents that are safe and well tolerated and lead patients to remission of symptoms. We present a retrospective analysis that assessed the efficacy and tolerability of adjunctive levetiracetam, a novel anticonvulsant agent, in the treatment of refractory anxiety.

Method: Forty patients with DSM-IV anxiety disorders, who were deemed partial responders or nonresponders to anxiolytic therapy, received adjunctive levetiracetam in a naturalistic fashion during the time period from January 2004 through December 2004. We conducted a retrospective chart review. The primary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) scale and the Clinical Global Impressions-Improvement (CGI-I) scale. Mean change from baseline to endpoint was assessed using 2-tailed paired t tests.

Results: Levetiracetam at a mean ± SD dose of 1969 ± 819 mg/day for a mean ± SD time period of 9.3 ± 5.1 weeks was generally well tolerated. Patients were markedly ill with a mean ± SD baseline CGI-S score of 6.2 ± 0.6. Patients improved significantly, with an endpoint CGI-S score of 4.2 ± 1.8 (p < .001) and CGI-I score of 2.6 ± 1.2. Adverse events were generally mild, and only 4 patients discontinued levetiracetam because of side effects.

Conclusion: These preliminary data suggest that levetiracetam may be an effective adjunctive treatment for patients with anxiety disorders who remain symptomatic despite initial anxiolytic therapy.