Anxiety

Question 1

Primary tx of Chronic generalized anxiety disorder?

Answer 1

Anti-depressant therapy (first line) – these have replaced benzodiazepines due to side effect profile, no risk of dependency and efficacy in other comorbid conditions.

Takes 2-4 weeks to begin to show anti-anxiety effects. [Venlafaxine and SSRIs are 1st line compared to TCA due to improved safety and tolerability.]

Question 2

Benzodiazepines in GAD?

Answer 2

Recommended for acute treatment of GAD when short-term relief is needed. It may also be used as adjunct during initiation of antidepressant therapy or to improve sleep.

My result in physiologic and psychologic dependence.

Use as initial adjuvant while SSRIs are titrated to effect dose, then taper pt off benzo while SSRI is continued.

Question 3

Busiprone in GAD?

Answer 3

2nd line agent for GAD - serotonin inhibitor

• gradual onset of 2 weeks
• no abuse potential
• no withdrawal reaciton
• no alcohol potentiation
• no sedative-hypnotic effect

Question 4

What are the last line medications for GAD when everything else fails?

Answer 4

1. hydroxyzine

2. pregabalin

Question 5

DOC panic disorders?

Answer 5

SSRIs [only use TCA and MAOI when SSRI is not used]

Question 6

Benzo tx for panic disorder?

Answer 6

Used concomitantly with antidepressants or as monotherapy. This is not preferred for long-term treatment and may be used when patients fail severe antidepressant trials.

Alprazolam - may cause rebound anxiety b/t doses and is associated with withdrawal syndromes (esp seizures)

Question 7

Tx social anxiety disorders?

Answer 7

SSRI - may take 8-12 weeks for onset of response

Question 8

Tx of obsessive compulsive disorder?

Answer 8

• Clomipramine, fluoxetine, fluvoxamine,
paroxetine, and sertraline are all FDA approved
for OCD.
• SSRIs have a better adverse effect profile.
• For highly anxious OCD patients, adding a
benzodiazepine or an antipsychotic drug may be
beneficial.

Question 9

Tx PTSD?

Answer 9

• SSRIs are the first-line drugs.
• Other antidepressants (e.g., venlafaxine, TCAs
and MAOIs) can also be effective.
• Sertraline and paroxetine are both approved for
the acute treatment of PTSD.
• Sertraline is approved for the long-term
management of PTSD.

Question 10

Tx performance anxiety?

Answer 10

B blockers with high lipophilicity [propranolol and nadolol]