Efficacy and safety of medical treatment of chronic anxiety disorders in diabetic patients

Aim.
To study efficiency and safety of hydroxizine (H) and tofisopam (T) therapy in DM patients with generalized organic anxiety disorders and subsyndromicanxiety the overall prevalence of which among diabetic patients amounts to 45-50%.
Materials and methods.
This open prospective randomized comparative study included 60 DM patients with anxiety disorders (AD) of whom 95%presented with arterial hypertension. The medicines were prescribed at mean therapeutic doses for 3 months followed by 1 month withdrawal period.The efficiency of anxiolytics was estimated from dynamic patterns of reactive anxiety (RA), personal anxiety (PA, Spielberger scale), somatic anxietysymptoms (Giessen questionnaire), HbA_1c level, systolic and diastolic AP (SAP, DAP), heart rate.
Results.
Therapy with anxiolytics for 3 months resulted in the decrease of the HbA_1c level from 7.9?1.4 to 7.4?1.4%, total somatic anxiety scorefrom 38.0?13.2 to 31.5?12.2, PA from 52.5?9.7 to 47.1?8.8, RA from 32.3?9.0 to 25.5?9.3, SAP from 141.4?12.4 to 129.8?13.5 mmHg,DAP from 82.3?7.4 to 77.8?8.6 mm Hg, HR from 76.3?9.5 to 72.7-5.6 (in all cases p<0.05). Subgroups treated with H and T had similarclinical, laboratory, and psychological characteristics before and after therapy. However, H caused a more pronounced fall in PA scores than Twhereas T reduced DAP and HR to a greater degree than H. Termination of therapy was not accompanied by clinical symptoms of withdrawal syndrome.All the above parameters remained stable within 1 month after treatment excepting DAP in the subgroup given T (a rise from 76.5?5.6 mmHg 3 months after the onset of therapy to 81.0?8.3 mm Hg 1 month after its withdrawal (p<0.05). By the end of the treatment period, 7 patientsfrom the H subgroup and 6 from the T subgroup dropped out of the study including 1 and 0 ones respectively who discontinued presumably due to thedrug-related adverse events.
Conclusion.
1. Anxiolytic therapy of AD in patients with DM significantly reduces intensity of chronic anxiety; this effect persists within 1 month afterthe termination of therapy. 2. Simultaneously, manifestations of major risk factors of vascular disorders (glycated hemoglobin, AP) decrease. 3. Meantherapeutic doses of atarax and grandaxin are well tolerated and safe for DM patients who do not develop withdrawal syndrome after the terminationof therapy. 4. Despite comparable, on the whole, results of therapy with atarax and grandaxin, the former agent appears to have greater effect on thepsychological component and the latter on the somatic (vegetative) component of AD.

diabetes mellitus, anxiety disorders, therapy, hydroxizine, tofisopam

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