In 1999, a selective serotonin reuptake inhibitor (SSRI) was introduced to the clinic in Japan. This introduction greatly improved the treatment of anxiety disorder and understanding of its pathology. Since SSRI with high selectivity and no other mechanism of action is effective for treating anxiety disorder, increasing extracellular serotonin concentrations in the brain is concluded to directly alleviate the symptoms of anxiety disorder. In addition, on the basis of the details of neural circuits of anxiety and fear, which have been elucidated since 1993, several animal studies have shown that the mechanism of anxiolytic action of SSRIs is suppressing the neural function of the amygdala and their action is mediated through the stimulation of the 5-HT1A receptor. The hypotheses obtained from these animal experiments are also supported by human imaging studies using fMRI. By elucidating the mechanism of action of SSRI, it is expected that it will become possible in the future to understand the pathology of anxiety disorders and develop the new treatment of anxiety disorders from the viewpoints of neural circuits and neurotransmitters.
"},{"@language":"ja","@value":"1999年に選択的セロトニン再取り込み阻害薬（SSRI）が本邦臨床に導入されて，不安症の治療および病態の理解は大きく進歩した。選択性が強く，セロトニン再取り込み阻害作用以外の作用機序をもたないSSRIが不安症治療に有効であることから，脳内で細胞外セロトニン濃度を増やすことが，直接不安症の症状を改善させるということができる。さらに，不安・恐怖の神経回路が1993年以降に詳細に解明されたことを契機に，SSRIが扁桃体に作用し，その神経機能を抑制することにより抗不安作用をもたらすこと，その作用は5-HT1A受容体への刺激を介していることが動物実験で明らかになった。これらの動物実験から得られた仮説はfMRIを使ったヒトの画像研究でも支持されている。SSRIの作用機序解明により，不安症の病態と治療を神経回路，神経伝達物質の観点から不安症の病態を理解し，新規治療法を開発することが将来可能になることが期待される。
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