Innovative approaches to the treatment of anxiety and stress-related disorders (resolution of the Expert Council)

Anxiety and stress-related disorders are characterized by high prevalence, comorbidity and resistance to existing treatments in a significant proportion of patients. Treatment for anxiety spectrum disorders includes an educational program, psychotherapy and the use of medication. The most effective forms of psychotherapy are cognitive behavioural therapy and various relaxation techniques; in recent years, psychological methods have often been used not only in face-to-face sessions but also online. First-line treatments for anxiety spectrum disorders include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In some cases, patients with anxiety spectrum disorders do not respond to SSRIs and SNRIs, and many patients discontinue their medication due to adverse effects; therefore, the search for new drugs remains a priority.

This article summarises the findings of the Expert Council meeting (April 2026) dedicated to maritupirdine (Aviandr®), a multi-target antagonist of serotonin, a₂-adrenergic and H₁-histamine receptors. Based on preclinical and clinical data, including studies on generalized anxiety disorder and post-COVID-19 adjustment disorder, the drug's anxiolytic, antidepressant and pro-cognitive effects, favourable safety profile and absence of withdrawal syndrome have been confirmed. A pro-cognitive effect of the drug has been observed, consistent with data on the blockade of 5-HT6 and 5-HT7 receptors.

Experts conclude that the restrictions on the use of maritupirdine in patients with organic brain disorders and epilepsy are not sufficiently justified. Further research into maritupirdine in organic mental disorders, including cognitive impairment and dementia, is required. The use of maritupirdine is appropriate for adjustment disorders of various aetiologies. Maritupirdine's favourable tolerability and safety profile is a significant advantage in the treatment of patients with anxiety disorders and those with stress-related disorders.

1. Petelin DS, Sorokina OYu, Galiautdinova AN, et al. Anxiety Disorders in Clinical Practice (Clinical Observation and Literature Review). Meditsinskiy sovet = Medical Council. 2024;18(12):52-60 (In Russ.). doi: 10.21518/ms2024-297

2. Bobrov AE, Usatenko EV. The concept of anxiety disorders: main development trends. Social and Clinical Psychiatry. 2021;31(4):62-7 (In Russ.).

3. Stein DJ, Scott KM, de Jonge P, Kessler RC. Epidemiology of anxiety disorders: from surveys to nosology and back. Dialogues Clin Neurosci. 2017;19(2):127-36. doi: 10.31887/DCNS.2017.19.2/dstein

4. Zhou J, Li S, Song Y, et al. Global, Regional, and National Trends in the Burden of Anxiety Disorders From 1992 to 2021: An Age – Period – Cohort Analysis Based on the Global Burden of Disease Study 2021. Depress Anxiety. 2025;2025:4178541. doi: 10.1155/da/4178541

5. Combs H, Markman J. Anxiety disorders in primary care. Med Clin North Am. 2014;98(5):1007-23. doi: 10.1016/j.mcna.2014.06.003

6. Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022;328(24):2431- 45. doi: 10.1001/jama.2022.22744

7. Neznanov NG, Martynikhin IA, Mosolov SN. Diagnosis and treatment of anxiety disorders in Russia: the results of a web-based survey of psychiatrists. Current Therapy of Mental Disorders. 2017;(2):2-15 (In Russ.). doi: 10.21265/PSYPH.2017.41.6437

8. Ohi K, Fujikane D, Takai K, et al. Clinical features and genetic mechanisms of anxiety, fear, and avoidance: A comprehensive review of five anxiety disorders. Mol Psychiatry. 2025;30(10):4928-36. doi: 10.1038/s41380-025-03155-1

9. Esin RG, Khaibullina DK. Somatic masks of anxiety disorder and therapy opportunities. Meditsinskiy sovet = Medical Council. 2022;(23):102-9 (In Russ.). doi: 10.21518/2079-701X-2022-16-23-1

10. Volel BA, Petelin DS, Akhapkin RV, Malyutina AA. Cognitive impairment in anxiety disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(1):78-82 (In Russ.). doi: 10.14412/2074-2711-2018-1-78-82

11. Robinson OJ, Vytal K, Cornwell BR, Grillon C. The impact of anxiety upon cognition: perspectives from human threat of shock studies. Front Hum Neurosci. 2013;7:203. doi: 10.3389/fnhum.2013.00203

12. Doherty AM, Jabbar F, Kelly BD, Casey P. Distinguishing between adjustment disorder and depressive episode in clinical practice: The role of personality disorder. J Affect Disord. 2014;168:78-85. doi: 10.1016/j.jad.2014.06.034

13. Vancappel A, Chkili R, Eberle DJ, et al. Exploring Characteristics of Preoccupation and Failure to Adapt Among Patients Suffering From Adjustment Disorder: A Qualitative Study. Clin Psychol Eur. 2024;6(2):e11565. doi: 10.32872/cpe.11565

14. Esipov AV, Samushiya MA, Ivolgin AF, et al. New opportunities for therapy of adjustment disorder in combat participants: results of a study on the domestic drug Aviandr. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;125(3):62-9 (In Russ.). doi: 10.17116/jnevro202512503162

15. Perkonigg A, Lorenz L, Maercker A. Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study. Int J Clin Health Psychol. 2018;18(3):209-17. doi: 10.1016/j.ijchp.2018.05.001

16. Shao X, Dong Z, Zhang S, et al. The relationship between negative emotions and adjustment disorder in young adults: the mediating role of rumination and insomnia. Front Psychiatry. 2025;16:1474108. doi: 10.3389/fpsyt.2025.1474108

17. Quero S, Palau-Batet M, Tur C, et al. Effect of an internet-based intervention for adjustment disorder on meaning in life and enjoyment. Curr Psychol. 2023;42(24):20543-55. doi: 10.1007/s12144-022-03177-w

18. Maercker A, Bachem RC, Lorenz L, et al. Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study. JMIR Ment Health. 2015;2(2):e15. doi: 10.2196/mental.4157

19. Anastasia A, Colletti C, Cuoco V, et al. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder. Neuropsychiatr Dis Treat. 2016;12:737-43. doi: 10.2147/NDT.S92637

20. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(1):S1. doi: 10.1186/1471-244X-14-S1-S1

21. Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. Adv Exp Med Biol. 2020;1191:237-61. doi: 10.1007/978-981-32-9705-0_15

22. Latas M, Vucinic Latas D, Spasic Stojakovic M. Anxiety disorders and medical illness comorbidity and treatment implications. Curr Opin Psychiatry. 2019;32(5):429-34. doi: 10.1097/YCO.0000000000000527

23. Mosolov SN. Anxiety and depressive disorders (comorbidity and therapy). Moscow; 2007 (In Russ.).

24. Chen X, You J, Li J, et al. Functional connectivity characteristics of epilepsy with anxiety: A resting-state functional near-infrared spectroscopy study. Medicine (Baltimore). 2025;104(22):e42660. doi: 10.1097/MD.0000000000042660

25. Aksenova YuO, Morozova MA, Zhirov IV, et al. The relationship between cognitive and psychoemotional disorders in patients with chronic heart failure. Current Therapy of Mental Disorders. 2026;(1):10-6 (In Russ.). doi: 10.48612/psyph/gh2n-b4xk-4dgv

26. Chun HYY, Newman R, Whiteley WN, et al. A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design. J Psychosom Res. 2018;104:65- 75. doi: 10.1016/j.jpsychores.2017.11.010

27. Stein LA, Goldmann E, Zamzam A, et al. Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke. Front Neurol. 2018;9:890. doi: 10.3389/fneur.2018.00890

28. Akarachkova ES. Anxiety disorders in a patient with chronic neurological diseases. Diagnostic and management procedures in neurological practice. Russian Medical Inquiry. 2025;9(11):817-22 (In Russ.). doi: 10.32364/2587-6821-2025-9-11-7

29. Tenea-Cojan ST, Dinescu VC, Gheorman V, et al. Exploring Multidisciplinary Approaches to Comorbid Psychiatric and Medical Disorders: A Scoping Review. Life (Basel). 2025 Feb 6;15(2):251. doi: 10.3390/life15020251

30. Polak-Szabela A, Wronska I, Glowacka M. Symptoms of Emotional Disorders and Their Co-Occurrence with Adherence Levels in Individuals Aged 55 and Older with Chronic Diseases. J Clin Med. 2025;14(18):6415. doi: 10.3390/jcm14186415

31. Horwitz TB, Sarfan LD, Milner AE, et al. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) in Community Mental Health: Evaluating SelfReported Psychiatric Disorders as a Predictor of Symptoms and Treatment Outcome. Res Sq. 2025 Aug 6:rs.3.rs-7189279. doi: 10.21203/rs.3.rs-7189279/v1

32. Suradom C, Wongpakaran N, Wongpakaran T, et al. Mediation model of comorbid anxiety disorders in late-life depression. Ann Gen Psychiatry. 2020;19:63. doi: 10.1186/s12991-020-00313-3

33. Frolova VI, Egiazaryan DK. Current concepts of the pathogenesis and treatment of generalized anxiety disorder. Current Therapy of Mental Disorders. 2025;(2):57-64 (In Russ.). doi: 10.48612/psyph/1xte-3z82-eek1

34. Ivashchenko AA, Morozova MA, Vostokova NV, et al. Safety and efficacy of aviandr in patients with generalized anxiety disorder: A multicenter, randomized, doubleblind, placebo-controlled, dose-finding, pilot study. J Psychiatr Res. 2021;143:436-44. doi: 10.1016/j.jpsychires.2021.10.008

35. Kostyukova EG. Generalized anxiety disorder: principles of diagnosis, therapy, and problems specific to Russia. Current Therapy of Mental Disorders. 2024;(2):23-31 (In Russ.). doi: 10.21265/PSYPH.2024.31.31.003

36. Smolyarchuk EA, Ivaschenko AV, Ivaschenko AA, et al. Multimodal mechanism of action of maritupirdine and the spectrum of potential clinical effects. Current Therapy of Mental Disorders. 2026;(2):75-84 (In Russ.). doi: 10.48612/psyph/enbu-rbm4-r5bu

37. Alonso J, Liu Z, Evans-Lacko S, et al. Treatment gap for anxiety disorders is global: results of the World Mental Health Surveys in 21 countries. Depress Anxiet. 2018;35:195- 208. doi: 10.1002/da.22711

38. Bandelow B, Reitt M, Rover C, et al. Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol. 2015;30:183-92. doi: 10.1097/YIC.0000000000000078

39. Windle E, Tee H, Sabitova A, et al. Association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions: a systematic review and meta-analysis. JAMA Psychiatry. 2019;77:294. doi: 10.1001/jamapsychiatry.2019.3750

40. Olthuis JV, Watt MC, Bailey K, et al. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2016;3:CD011565. doi: 10.1002/14651858.CD011565.pub2

41. Papola D, Miguel C, Mazzaglia M, et al. Psychotherapies for Generalized Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2024 Mar 1;81(3):250-9. doi: 10.1001/jamapsychiatry.2023.3971

42. De Vries YA, Roest AM, Burgerhof JGM, de Jonge P. Initial severity and antidepressant efficacy for anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder: an individual patient data meta-analysis. Depress Anxiety. 2018;35:515-22. doi: 10.1002/da.22737

43. Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet. 2019;393:768-77. doi: 10.1016/S0140-6736(18)31793-8

44. Breilmann J, Girlanda F, Guaiana G, et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2019;3:CD010677. doi: 10.1002/14651858.CD010677.pub2

45. Ivachtchenko AV, Lavrovsky Y, Okun I. AVN-101: A Multi-Target Drug Candidate for the Treatment of CNS Disorders. J Alzheimers Dis. 53(2):583-620. doi:10.3233/JAD-151146

46. Morozova MA, Safarova TP, Gluskina LYa, et al. Double-blind, placebo-controlled study of the efficacy and tolerability of Aviander® in the treatment of generalized anxiety disorder. Current Therapy of Mental Disorders. 2024;(3):2- 16 (In Russ.).

47. Popova VB, Antonova EA, Hlyabova PM, et al. Efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(7):131 (In Russ.). doi: 10.17116/jnevro2024124071131

48. Kinkulkina MA, Danilov AB, Volel BA, et al. Efficacy and safety of Aviandr® in patients with anxiety disorders after coronavirus infection (COVID-19): interim results of a multicenter observational post-registration study. Bulletin of Neurology, Psychiatry, and Neurosurgery. 2025;(1):104-16 (In Russ.). doi: 10.33920/med01-2501-10

49. Kinkulkina MA, Volel BA, Smolyarchuk EA, et al. Long-term treatment of generalised anxiety disorder with Aviandr: results of a 36-week post-registration observational study. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2025;17(6):44-53 (In Russ.). doi: 10.14412/2074-2711-2025-6-44-53