Anxiety Disorders: UCLA

Gitlin M. · Department of Psychiatry, UCLA School of Medicine, 300 UCLA Medical Plaza, Suite 2200, Los Angeles, CA 90095, USA. · Expert Opin Pharmacother. · Pubmed #14640925 No free full text.

Abstract: Sexual dysfunction caused by psychotropic medications has become an increasingly important clinical topic. Only recently have we acknowledged the extent to which many psychotropic medications, especially antidepressants and antipsychotics, cause sexual side effects. Prevalence rates of sexual side effects are extraordinarily difficult to estimate due to a variety of factors, such as the effect of the disorder being treated, comorbid disorders and baseline sexual dysfunction. Among the antidepressants, those with strong serotonergic properties have the highest rate of sexual side effects. Among the antipsychotics, those with greater D(2) blockade leading to increased prolactin levels are probably associated with more sexual dysfunction. Treatment approaches have been poorly developed for both antidepressants and antipsychotics. Antidotes for antidepressant-induced sexual dysfunction include bupropion, buspirone and sildenafil.

Masterman D. · Department of Neurology, David Geffen School of Medicine at University of California at Los Angeles, USA. · J Am Med Dir Assoc. · Pubmed #14613591 No free full text.

This publication has no abstract.

Stuber ML, Shemesh E, Saxe GN. · Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 48-240A NPI, Los Angeles, CA 90095, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #12725008 No free full text.

Abstract: Posttraumatic stress symptoms have been reported in response to various serious medical illnesses in adults and children. Not surprisingly, posttraumatic stress is probably more common in response to acute, life-threatening, events that are related to the illness. Emerging data suggest that children often experience life-saving medical procedures as traumatic, which puts caretakers and medical personnel in the role of perpetrators for the children. Trauma symptoms are also reported as common and severe in caregivers. Both of these issues have been previously poorly understood and should be addressed in assessment and treatment. As with other traumatic events, developmental considerations, the nature and severity of the event itself, social supports, and premorbid exposure to negative life events are also important issues to consider in developing appropriate interventions. The importance of developing prevention and treatment for PTSD in medically ill children and adults includes increased morbidity and mortality (e.g., nonadherence to medications) and psychiatric sequelae and decreased quality of life. Obstacles to systematic study of a psychiatric intervention for this group include difficulties assessing multidrug regimens and cognitive treatment effects in this group. The relative stability of social supports and the potential use of preventive measures make this an attractive population for intervention. Clinicians and researchers are encouraged to work together to develop and use uniform screening and assessment methods that will help to identify cases and facilitate the multicenter trials that are vital to increasing knowledge in this patient population.

Wood JJ, McLeod BD, Sigman M, Hwang WC, Chu BC. · Department of Psychology, University of California, Los Angeles 90095, USA. · J Child Psychol Psychiatry. · Pubmed #12553416 No free full text.

Abstract: Theories of anxiety development suggest that parental acceptance, control, and modeling of anxious behaviors are associated with children's manifestations of anxiety. This paper reviews research published in the past decade on the relation between parenting and childhood anxiety. Observed parental control during parent-child interactions was consistently linked with shyness and child anxiety disorders across studies. Mixed support for the role of parental acceptance and modeling of anxious behaviors was found in observational studies. However, there was little evidence supporting the contention that self-reported parenting style was related to children's trait anxiety. Because of limitations associated with past research, inferences about the direction of effects linking parenting and child anxiety cannot be made. A conceptual framework based on recent models of anxiety development (e.g., Vasey & Dadds, 2001) is presented to aid in the interpretation of extant research findings and to provide suggestions for future research and theory development. Improved methodological designs are proposed, including the use of repeated-measure and experimental designs for examining the direction of effects.

Rapkin AJ, Mikacich JA, Moatakef-Imani B, Rasgon N. · Department of Obstetrics and Gynecology, University of California, Los Angeles Medical Center, Box 951740, 27-139 CHS, Los Angeles, CA 90095, USA. · Curr Psychiatry Rep. · Pubmed #12441021 No free full text.

Abstract: Various mood and anxiety disorders are more prevalent in reproductive-aged women, and appear to be linked to hormonal and reproductive events. Premenstrual affective disorders consist of premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of mood or anxiety disorders. Postpartum affective disorders can range from postpartum "blues" to postpartum depression with or without psychosis, and also include anxiety disorders, such as panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In perimenopausal women, the vulnerability to mood and anxiety disorders is increased. All of these disorders share risk factors, and have etiologic features in common, such as exposure to the rise and fall of ovarian sex steroids. The following is a review of these syndromes and their etiology, diagnosis, and treatment.

Chang L, Heitkemper MM. · UCLA/CURE Neuroenteric Disease Program, Department of Medicine, and Brain Research Institute, UCLA School of Medicine, Los Angeles, California 90073, USA. · Gastroenterology. · Pubmed #12404243 No free full text.

Abstract: In the United States and other Western cultures, a greater number of women seek health care services for symptoms of functional pain disorders, including irritable bowel syndrome, than men. Recent clinical trials indicate that gender differences in responsiveness to drug therapy also occur. Several lines of inquiry have focused on explaining this gender-related difference due to the higher prevalence of these disorders in women. Evidence of a physiologic component is based on gender differences in gastrointestinal transit time, visceral sensitivity, central nervous system pain processing, and specific effects of estrogen and progesterone on gut function. Additional factors may play a role, including gender-related differences in neuroendocrine, autonomic nervous system, and stress reactivity, which are related to bowel function and pain. However, the link between these measures and gut motility or sensitivity remains to be clarified. Psychological characteristics, including somatization, depression, and anxiety as well as a history of sexual abuse, may also contribute to gender-related differences in the prevalence of irritable bowel syndrome. Although gender differences in the therapeutic benefit of serotonergic agents have been observed, less is known about potential differences in responsiveness to nondrug therapies for irritable bowel syndrome.

Mayer EA, Craske M, Naliboff BD. · Department of Medicine, University of California, Los Angeles, USA. · J Clin Psychiatry. · Pubmed #12108819 No free full text.

Abstract: Functional disorders of the digestive system, such as irritable bowel syndrome, are often associated with affective disorders, such as depression, anxiety, panic, and posttraumatic stress disorder (PTSD). Some of these associations are observed not only in clinical populations, but also in population-based samples, suggesting a relationship with pathophysiologic mechanisms underlying both gastrointestinal (GI) dysfunction and certain affective disorders. Sustained and acute life-threatening stressors play an important role in the onset and modulation of GI symptoms as well as in the development of affective disorders and PTSD. A neurobiological model is proposed that attempts to explain the development of visceral hypersensitivity, the neuroendocrine and autonomic dysfunction characteristic of functional GI disorders, as well as the overlap with affective disorders.

McCracken JT, Walkup JT, Koplewicz HS. · Division of Child and Adolescent Psychiatry, UCLA Neuropsychiatric Institute, Los Angeles, CA 90024, USA. · J Clin Psychiatry. · Pubmed #12027119 No free full text.

Abstract: Increasing research attention is being applied to studies of early-onset anxiety, with a focus on its phenomenology, etiology, and strategies for treatment. The impetus for these studies includes well-confirmed findings from epidemiologic surveys clearly demonstrating that, as a group, the anxiety disorders represent the most highly prevalent form of psychopathology in children and adolescents. Overall rates of childhood anxiety disorders are estimated to be from 6% to 10%, depending upon categories included and strategies for ascertainment. New work is currently being conducted in the form of large-scale rigorous treatment studies, and new investigations explore etiopathophysiologic aspects of anxiety in children and adolescents. Significant progress is being made in this important clinical area that should translate to improved outcomes through refined diagnosis and empirically tested treatments.

Freeman DB. · Department of Psychiatry, Harbor/UCLA Medical Center, Los Angeles, Calif., USA. · Case Manager. · Pubmed #11935611 No free full text.

This publication has no abstract.

Schore AN. · University of California at Los Angeles School of Medicine, Northridge, CA 91324, USA. · Aust N Z J Psychiatry. · Pubmed #11929435 No free full text.

Abstract: OBJECTIVE: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. METHOD: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. RESULTS: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. CONCLUSIONS: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.

McCollough M, Sharieff GQ. · Department of Medicine, University of California Los Angeles School of Medicine, Pediatric Emergency Medicine, Department of Emergency Medicine, Olive View-University of California Los Angeles Medical Center, Los Angeles, California, USA. · Emerg Med Clin North Am. · Pubmed #11826636 No free full text.

Abstract: Visits to the emergency department (ED) by neonates and their parents can cause anxiety for parents and the ED staff. Many of the presenting complaints are unique to the neonatal population, and an understanding of both common problems and true medical emergencies is paramount. This article discusses the complaints the EDs have seen more frequently as a result of earlier newborn discharges from hospitals.

Piacentini J, Chang S. · Child OCD, Anxiety, and Tourette's Disorder Program, UCLA-Neuropsychiatric Institute, USA. · Adv Neurol. · Pubmed #11530440 No free full text.

This publication has no abstract.

Lin KM. · Department of Psychiatry, Harbor-UCLA Research and Education Institute, Torrance 90502, USA. · J Clin Psychiatry. · Pubmed #11434414 No free full text.

Abstract: A growing number of studies clearly indicate the importance of race and ethnicity in the psychopharmacologic management of depression and anxiety disorders. The data highlight important pharmacokinetic, pharmacodynamic, and pharmacogenetic ethnic differences that may have profound implications for the efficacy and safety of psychotropic therapies. General treatment considerations based on these differences include greater attention to adverse event profiles, the possibility of improved clinical response at any given dose, and the potential need for lower starting doses and slower increases in dosage. Continued research in this area is clinically important as patients with increasingly divergent ethnic and cultural backgrounds seek treatment for a range of depressive and anxiety disorders.

Saxena S, Bota RG, Brody AL. · UCLA Obsessive-Compulsive Disorder Research Program, Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA, USA. · Semin Clin Neuropsychiatry. · Pubmed #11296309 No free full text.

Abstract: Advances in neuroimaging have led to a greater understanding of brain-behavior relationships in obsessive-compulsive disorder (OCD). This article provides an updated review and analysis of the structural and functional neuroimaging studies in OCD published to date and discusses how evidence from various types of neuroimaging studies has been synthesized to generate and test hypotheses regarding these relationships. We also review the basic science literature on the functional neuroanatomy of cortico-basal ganglia-thalamo-cortical circuits and integrate this information with neuroimaging data in OCD, to present a theoretical model of brain mediation of OCD symptoms and response to treatment. Taken together, neuroimaging studies indicate that OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, which may be attributable to an imbalance of tone between direct and indirect striato-pallidal pathways. Serotonergic drugs may ameliorate OCD symptoms by changing the relative balance of tone through the indirect versus direct orbitofrontal-subcortical pathways, thereby decreasing activity in the overall circuit that exists in the symptomatic state.

Craske MG, Pontillo DC. · Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. · Bull Menninger Clin. · Pubmed #11280959 No free full text.

Abstract: Cognitive theorists hypothesize that cognitive biases are a major component in the development and maintenance of anxiety disorders. These include attentional biases toward threat-related information, distorted judgments of risk, and selective memory processing. The empirical evidence for these cognitive biases in anxiety disorder populations is reviewed. Potential deleterious effects of these biases on the process of cognitive-behavioral therapy are also discussed, as are possible ways of overriding those effects and maximizing treatment efficacy.

Aikins DE, Craske MG. · Division of Adult Psychiatry, Department of Psychiatry, University of California, Los Angeles, USA. · Psychiatr Clin North Am. · Pubmed #11225509 No free full text.

Abstract: The hallmark feature of generalized anxiety disorder, worry, has been hypothesized to be a key factor in the production of threat-related information-processing biases in the domains of attention, memory, interpretation of ambiguity, and problem solving; however, worry and cognitive biases are not unique to generalized anxiety disorder. What may be unique to generalized anxiety disorder is the pervasive use of worry as a strategy to avoid intense negative effect and the broad domains in which these biases are exhibited, directly relating to the clinical observation that patients with generalized anxiety disorder worry about numerous life stressors. Also, the authors conclude that information-processing biases contribute to worry but that they are insufficient for the development of generalized anxiety disorder. Directions for future research and clinical implications are discussed.

Saxena S, Rauch SL. · Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles School of Medicine, USA. · Psychiatr Clin North Am. · Pubmed #10986728 No free full text.

Abstract: Functional neuroimaging studies have advanced the understanding of the brain mediation of OCD by orbitofrontal-subcortical circuitry, but much is still unknown. Phenotypic heterogeneity could account for many of the inconsistencies among previous neuroimaging studies of OCD. Current studies are seeking to find the neurobiological basis of OCD symptom subtypes and predictors of treatment response. Future studies combining genetics and basic neuroanatomic research with neuroimaging may clarify the cause and pathophysiology of OCD. Although many lines of evidence point to dysfunction of orbitofrontal-subcortical circuitry in patients with OCD, many questions remain unanswered. Some have suggested that orbitofrontal-subcortical hyperactivity in OCD may be the result of abnormal neuroanatomic development of these structures or a failure of pruning of neuronal connections between them, as occurs in normal development, but no postmortem neuroanatomic studies of OCD exist to delineate its pathophysiology. Interventions that directly alter the indirect-direct pathway balance within frontal-subcortical circuits will allow for direct testing of the pathophysiologic hypotheses presented here. The roles of various neurochemical systems in OCD are similarly unclear. Although an abundance of indirect evidence suggests serotonergic abnormalities in patients with OCD, no direct evidence demonstrates what those abnormalities are or whether they are primary or secondary phenomena in patients with OCD. Ongoing studies of 5-HT synthesis in the brains of patients with OCD may shed light on this question.

Piacentini J, Bergman RL. · Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles School of Medicine, USA. · Psychiatr Clin North Am. · Pubmed #10986725 No free full text.

Abstract: Childhood OCD is a chronic and commonly disabling disorder with a lifetime prevalence of 2% to 3%. Traditionally OCD was a neglected diagnosis, but renewed research interest over the past decade has led to significant advances in the understanding of the disorder in young people. OCD is relatively consistent across the age span in terms of prevalence, phenomenology, etiology, and response to treatment. Comorbidity, especially depression and other anxiety disorders, is common in children with OCD and may exert a negative influence on treatment response and long-term outcome. Nevertheless, CBT and SSRI therapy have been shown to be effective and well-tolerated therapies for children with OCD.

López SR, Guarnaccia PJ. · Department of Psychology, University of California, Los Angeles 90095-1563, USA. · Annu Rev Psychol. · Pubmed #10751981 No free full text.

Abstract: We review cultural psychopathology research since Kleinman's (1988) important review with the goals of updating past reviews, evaluating current conceptualizations and methods, and identifying emerging substantive trends. Conceptual advances are noted, particularly developments in the definition of culture and the examination of both culture-specific and cultural-general processes. The contributions of the Culture and Diagnosis Task Force for DSM-IV and the World Mental Health Report are reviewed and contrasted. Selected research on anxiety, schizophrenia, and childhood disorders is examined, with particular attention given to the study of ataque de nervios, social factors affecting the course of schizophrenia, and cross-national differences in internalizing and externalizing problems in children. Within the last ten years, cultural psychopathology research has become a significant force. Its focus on the social world holds promise to make significant inroads in reducing suffering and improving people's everyday lives.

Pynoos RS, Steinberg AM, Piacentini JC. · Trauma Psychiatry Service, University of California at Los Angeles 90024, USA. · Biol Psychiatry. · Pubmed #10599482 No free full text.

Abstract: Empirical findings regarding childhood traumatic stress are placed within a developmental life-trajectory model that incorporates a tripartite etiology of posttrauma distress. This approach recognizes an intricate matrix of child-intrinsic factors, developmental maturation and experience, life events, and evolving family and social ecologies. Of central developmental importance in the field of traumatic stress is the ontogenesis of appraisal, emotional response, emotional and physiological regulation, and consideration of protective action with regard to danger. The complexity of traumatic situations and their aftermath suggests the relevance of multiple stress diatheses in understanding individual variability in proximal and distal effects. Neurobiological systems that subserve danger mature over childhood and adolescence. Neurophysiological and neurohormonal studies among traumatized children and adolescents suggest potential neurodevelopmental stage-related vulnerabilities within these systems. Advances in child development and traumatic stress provide tools for investigating proximal and distal interplay of psychopathology, disturbances in the acquisition and maintenance of developmental competencies, and life-trajectory outcomes. A developmental psychopathology model suggests different avenues by which dangerous circumstances, childhood traumatic experiences, and posttraumatic stress disorder (PTSD) can intersect with other anxiety disorders over the life span.

Mayer EA. · Division of Digestive Diseases, University of California Los Angeles School of Medicine, USA. · Am J Med. · Pubmed #10588168 No free full text.

Abstract: In response to perceived or experienced change that is considered threatening to the individual, the central nervous system mounts a stereotypic response that decreases the sensitivity to pain, modulates the autonomic nervous system outflow, and activates the hypothalamic-pituitary-adrenal (HPA) axis. This response of the "emotional motor system" may or may not be associated with the conscious experience of feelings of fear or anxiety. Alterations in these response systems (either up- or downregulation) may produce symptoms, such as viscero-somatic hypersensitivity, altered bowel habits, or increased anxiety.

Piacentini J. · Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #10442232 No free full text.

Abstract: Obsessive-compulsive disorder is a chronic, recurrent, and often disabling disorder in childhood. Comorbid emotional and behavioral disturbance and family dysfunction are common and can serve to complicate both course of illness and treatment outcome. Although traditional psychotherapies have not been shown to be effective for treating core OCD symptoms, controlled trials with adults have shown cognitive-behavioral approaches that include ERP to be highly effective in treating the disorder. The recent development and open evaluation of a handful of standardized and developmentally sensitive ERP-based treatment protocols for childhood OCD indicates that this treatment approach is similarly effective and well-tolerated in teh younger age group. These studies also suggest that adjunctive interventions including family involvement in treatment, anxiety management training, cognitive restructuring, contingency management, and supportive therapy may enhance the efficacy of ERP through the enhancement of treatment compliance and motivation. More study is needed to evaluate the best use of medication and CBT in children and adolescents.

McCracken JT, Suddath R, Chang S, Thakur S, Piacentini J. · Division of Child and Adolescent Psychiatry, UCLA Neuropsychiatric Institute and David Geffen School of Medicine, Los Angeles, California 90024-1759, USA. · J Child Adolesc Psychopharmacol. · Pubmed #18928414 No free full text.

Abstract: OBJECTIVES: The primary aim of the study was to evaluate the effectiveness and tolerability of open-label olanzapine on motor and vocal tics in children and adolescents with Tourette syndrome (TS). Secondary aims included assessing the response of TS-associated disruptive behaviors to olanzapine exposure. METHOD: Twelve children and adolescents (mean age 11.3 +/- 2.4 years, range 7-14 years) with Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) TS were enrolled in a single-site, 6-week, open-label, prospective, flexible-dose design in outpatients receiving monotherapy with olanzapine. Standardized ratings of tic symptoms, disruptive behaviors, and aggression were obtained, along with adverse events and safety data. RESULTS: Over the 6-week trial, olanzapine administration was associated with a significant decrease in total tic severity as measured by the Yale Global Tic Severity Scale (30% reduction by week 6; effect size 0.49). A significant majority of subjects were rated as "much improved" or "very much improved" on the Clinical Global Impressions-Improvement Scale (GCI-I) by both clinicians (67%; 8/12) and parents (64%; 7/11). Attention-deficit/hyperactivity disorder (ADHD) symptoms showed significant improvements from baseline for both inattention (33% decrease) and hyperactive/impulsivity (50% decrease) scores (effect sizes 0.44 and 0.43, respectively). Aggression was also decreased as assessed by fewer numbers of aggressive episodes on the Overt Aggression Scale (OAS). Little change in anxiety symptoms was noted. The most widely reported side effects were drowsiness/sedation and weight gain; adverse events were generally well tolerated. Mean weight gain of 4.1 +/- 2.0 kg was observed over the 6-week trial, a mean percent change of 8.4 +/- 4.4 (p < 0.001). CONCLUSIONS: Additional studies of the benefits of olanzapine treatment for tic control as well as the commonly associated co-morbid features of TS are indicated, especially if approaches to predict or minimize weight gain can be determined.

Bystritsky A, Kaplan JT, Feusner JD, Kerwin LE, Wadekar M, Burock M, Wu AD, Iacoboni M. · Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095-6968, USA. · J Clin Psychiatry. · Pubmed #18572984 No free full text.

Abstract: BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that holds promise for treating several psychiatric disorders. Yet the most effective location and parameters for treatment need more exploration. Also, whether rTMS is an effective treatment for individuals with a DSM-IV diagnosis of generalized anxiety disorder (GAD) has not been empirically tested. The goal of this pilot study was to evaluate whether functional magnetic resonance imaging (fMRI)-guided rTMS is effective in reducing symptoms of GAD. METHOD: Ten participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program, and between the ages of 18 and 56 years were enrolled in the study from August 2006 to March 2007. A pretreatment symptom provocation fMRI experiment was used to determine the most active location in the prefrontal cortex of the participants. Ten participants completed 6 sessions of rTMS over the course of 3 weeks, stereotactically directed to the previously determined prefrontal location. The primary efficacy measures were the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions-Improvement of Illness (CGI-I) scale. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of 1 or 2 ("very much improved" or "much improved," respectively). RESULTS: Overall, rTMS was associated with significant decreases in HAM-A scores (t = 6.044, p = .001) indicative of clinical improvement in GAD symptoms. At endpoint, 6 (60%) of the 10 participants who completed the study showed reductions of 50% or more on the HAM-A and a CGI-I score of 1 or 2; those 6 subjects also had an endpoint HAM-A score < 8, therefore meeting criteria for remission. CONCLUSION: Results of the current study suggest that fMRI-guided rTMS treatment may be a beneficial technique for the treatment of anxiety disorders. Limitations include a small sample size and open-label design with a technology that may be associated with a large placebo response. These limitations necessitate further research to determine whether rTMS is indeed effective in treating anxiety disorders.

Bystritsky A, Kerwin L, Feusner JD. · Department of Psychiatry, University of California, Los Angeles, CA, USA. · J Altern Complement Med. · Pubmed #18307390 No free full text.

Abstract: BACKGROUND: Rhodiola rosea is an herbal supplement that many in the general population in Russia and elsewhere in the world have used for decades to alleviate everyday anxiety, depression, and insomnia. Whether R. rosea is effective in reducing similar symptoms in clinical samples is unknown. The goal of this pilot study was to evaluate whether R. rosea is effective in reducing symptoms of generalized anxiety disorder (GAD). METHOD: Ten (10) participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program and between the ages of 34 and 55, were enrolled in this study from November 2005 to May 2006. Participants received a total daily dose of 340 mg of R. rosea extract for 10 weeks. Assessments included the Hamilton Anxiety Rating Scale (HARS), the Four-Dimensional Anxiety and Depression Scale, and the Clinical Global Impressions of Severity/Improvement Scale. RESULTS: Individuals treated with R. rosea showed significant decreases in mean HARS scores at endpoint (t=3.27, p=0.01). Adverse events were generally mild or moderate in severity, the most common being dizziness and dry mouth. CONCLUSIONS: Significant improvement in GAD symptoms was found with R. rosea, with a reduction in HARS scores similar to that found in clinical trials. These preliminary findings warrant further exploration of treatment with R. rosea in clinical samples.