Use of Bifren® in subthreshold anxiety, adjustment disorders and asthenia in primary care and internal medicine practice

Kravchenko M.V.

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Use of Bifren® in subthreshold anxiety, adjustment disorders and asthenia in primary care and internal medicine practice

October 13, 2026

Kravchenko M.V.

УДК: УДК 616.89-008.428:616.8-009.17

Keywords :

Resume

Patients with subthreshold anxiety, adjustment disorders, asthenic conditions and sleep disturbances usually consult
a family physician, internist, cardiologist, neurologist or gastroenterologist rather than a psychiatrist, presenting with somatic
complaints and reduced work capacity. These conditions do not
meet the full ICD-11 criteria for anxiety or depressive disorders,
yet they impair quality of life and lead to repeated visits, unnecessary investigations and unjustified escalation of treatment for the
underlying disease. This article reviews the prevalence and clinical presentation of subthreshold conditions in primary care and
internal medicine, describes brief validated instruments for their
objective assessment (GAD-7, HADS, ISI, ADNM-20) and lists the
conditions that must be excluded before a subthreshold diagnosis is made. The evidence on phenibut, the active substance of
Bifren^®, is analysed, including a systematic review of clinical trials
and case reports of dependence and intoxication, as well as an
observational study in general practice patients with adjustment
disorder, with due consideration of their limitations. The mechanism of action, dosing, safety profile and drug interactions are
described; a patient management algorithm with three checkpoints is proposed, and the limits of subthreshold care and the
criteria for specialist referral are defined. Available data indicate
acceptable tolerability of phenibut at therapeutic doses, whereas
serious risks are associated mainly with uncontrolled use of
doses substantially exceeding those recommended.

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