PTSD has aroused debate especially surrounding the definition of the traumatic event that anchors the symptoms. It is not controversial that intense traumatic events qualify as criterion, but what about purely psychosocial events without physical injury? DSM IV does not require that someone directly experience the trauma. The traumatic event may just be witnessed or heard about via television events, etc. Suggestions are being made that PTSD criteria be tightened up such that only those directly experiencing a trauma receive the diagnosis. If this comes to fruition in DSM 5, look for fireworks.

Deep Brain Stimulation – the bilateral implantation of two electrodes at specific areas in the brain where they release continuous, low-voltage electrical shocks – is gaining more attention for the treatment of severe, intractable OCD.

Anti-anxiety agents:

It comes as no surprise to me that no new releases occurred in this drug category during 2010. The most recent approval was Edular (zolpidem tartrate) in the latter part of 2009. Sound familiar? Edular is simply a brand-name clone of the now generically available Ambien. It is an oral disintegrating preparation, which means it doesn’t have to be taken with fluids. One gets to pay about $150 for this little perk.

Benzodiazepines remain in widespread use for managing adjustment disorders with anxious mood. Prescriber decisions as to which benzodiazepine to use are typically based on the anxiety disorder being treated, as well as on the onset of action and the duration of action of the benzodiazepine. For example, in the treatment of generalized anxiety disorder, a long half-life benzodiazepine such as Klonopin is often employed, due to its long duration of action. At low dosage ranges, benzodiazepines alleviate anxiety. At increasingly higher doses, they have skeletal muscle relaxation properties, act as anticonvulsants and promote sleep.

Absolutely none of the anxiolytic sleep agents (Ambien, Sonata, Lunesta, Edular) consistently keep people asleep. Television advertisements continue to be misleading.

Once the electrodes are surgically in place, clinicians control how the electrical impulses are delivered to the brain via a battery-operated, pacemaker device outside of the body. Through a trial and error process, physicians assess what electrical activity patterns are most apt to help patients while producing the least side effects.

Obsessive-compulsive disorder is an anxiety condition characterized by persistent thoughts and compulsions. It is a chronic condition fraught with considerable suffering, shame, guilt and self-doubt, and is often incapacitating as well. Obsessions are recurring anxiety-producing thoughts such as a fear of contamination, or “germophobia,” and safety concerns. Compulsions are ritualistic behavioral responses performed in response to obsessions. Common compulsions include repeated washing of the hands and repeated checking of door and window locks.

FDA approval of deep brain stimulation for OCD suggests that this regulatory body believes that this procedure might help ameliorate anxiety – a dominant factor in the disorder. The technique is reserved for intractable obsessive-compulsive disorder when conventional management, such as cognitive-behavioral therapies and medication, has failed to generate measurable results.

The device approved by the FDA is named Reclaim and is manufactured by Medtronic Inc. of Minneapolis, Minnesota.