Anxiety

Question 1

what are the 1st line meds for general anxiety disorder?

Answer 1

SSRI, SNRI, pregabalin

Question 2

what are 2nd line meds for general anxiety disorder?

Answer 2

Quetiapine, Imipramine, Bupropion, Benzodiazepines (Alprazolam, bromazepam, diazepam and clonazepam), Buspirone, Hydroxyzine

Question 3

what are 3rd line meds for general anxiety disorder?

Answer 3

adjuvent pregabalin, mirtazapine, SGAs (olanzapine, quetiapine, aripiprazole)

Question 4

Symptoms may improve in __ weeks but optimal response occurs after __ weeks. Minimum trial should be __ weeks.

Answer 4

Symptoms may improve in 2-8 weeks but optimal response occurs after 12 weeks. Minimum trial should be 6-8 weeks.

Question 5

Duration of therapy

Answer 5

1-2 years

Question 6

When are benzos useful?

Answer 6

during the beginning of therapy and for flare ups

Question 7

When should benzos be avoided?

Answer 7

if there’s comorbid substance use disorder or history

Question 8

Benzo use should be limited to

Answer 8

6-8 weeks

Question 9

Are benzos safe in pregnancy?

Answer 9

Not in the 1st trimester, should be avoided due to risk of congenital malformations, afterwards their use may be warranted.

Question 10

What can be used for anxiety in pregnancy? what to avoid? what’s preferred?

Answer 10

can use SSRI, SNRI, benzos (except T1)
avoid paroxetine
preferred: citalopram, escitalopram, sertraline

Question 11

What can be used for anxiety during breastfeeding? what to avoid?

Answer 11

use: paroxetine, sertraline
avoid: benzos (sedation, accumulation, impairment)

Question 12

Benzo AE

Answer 12

drowsiness, psychomotor impairment, fatigue, muscle weakness, reduced concentration, confusion, dysarthria, ataxia, paradoxical agitation (rare), retrograde amnesia (especially with high doses), tolerance & abuse (especially with rapid onset alprazolam & diazepam), and withdrawal (rebound anxiety, nausea, tremors, seizures).

Question 13

SSRI onset

TCA onset

Answer 13

4-6 weeks

2-3 months