Anxiety Drugs

Question 1

What is the drug of first choice for anxiety?

Answer 1

An antidepressant usually an SSRI

Question 2

SSRIs can be used to treat what?

Answer 2

Generalized anxiety disorder (GAD) 
Social Anxiety Disorder (SAD)
Posttraumatic Stress Disorder (PTSD)
Panic Disorder (PD)
Obsessive Compulsive Disorder (OCD)

Question 3

As with the treatment of depression, antidepressants may take how long to relieve anxiety?

Answer 3

Several Weeks

Question 4

Benzodiazepines are effective for most forms of anxiety, but produce pharmacologic dependence and have limited benefit in OCD or PTSD. They are generally recommended for what?

Answer 4

Only for short term or intermittent use in anxiety disorders

Question 5

The goals of therapy for GAD are to acutely reduce the severity and duration of anxiety symptoms and restore overall functioning. Therefore what are first line agents for management of chronic GAD?

Answer 5

Antidepressants (Reduce the psychic symptoms of anxiety)
–they have replaced benzos for chronic GAD due to side effects and dependency
Venlafaxine and SSRIs are preferred over TCAs due to improved safety and tolerability

Question 6

What is the most effective and commonly used treatment for the management of short term anxiety?

Answer 6

Benzodiazepines

• -acute treatment of GAD when short term relief is needed.
• -act quickly
• -can be used an an initial adjunct while SSRIs are titrated to an effective dose

Question 7

What are the second line and alternative agents for GAD?

Answer 7

Buspirone: second line

Hydroxyzine and Pregablin: alternative

Question 8

Moving on to panic disorder what is the objectives of treatment?

Answer 8

Reduce the severity and frequency of panic attacks, reduce anticipatory anxiety and agoraphobic behavior, and minimize symptoms of depression or other comorbid disorders.
–long term goal is to achieve and sustain remission

Question 9

What drugs are used for Panic Disorder?

Answer 9

SSRIs: drug of choice
TCA or MAOI can be used if SSRI is not effective
Benzos are often used concomitantly with antidepressants
Alprazolan: may cause rebound anxiety between doses and has been associated with a withdrawal syndrome.

Question 10

Social Anxiety Disorder (SAD), what is the goal of treatment?

Answer 10

Acute: reduce physiologic symptoms of anxiety, fear of social situations, and phobic behaviors
Long term: restore social functioning and improve the patients quality of life

Question 11

What are the drugs of choice for SAD?

Answer 11

SSRIs are considered the drugs of choice based on their tolerability and efficacy for SAD as well as comorbid disorders
–onset of response for antidepressants is delayed may be as long as 8 to 12 weeks

Question 12

What are the goals of therapy for OCD?

Answer 12

Reduction in the frequency of obsessive thoughts and in time spent performing compulsive acts and reduction in the degree of anxiety.

Question 13

What are the treatments for OCD?

Answer 13

Clomipramine (TCA)
Fluoxetine (SSRI)
Fluvoxamine 
Paroxetine (SSRIs)
Sertraline (SSRI)
--SSRIs have a more benign adverse effect profile

Question 14

Moving on to PTSD what is the treatment for this?

Answer 14

Antidepressants
–also effective for concurrent depression and anxiety disorders
SSRIs are first line though
Sertraline and Paroxetine are approved for acute treatment of PTSD
Sertraline: long term treatment of PTSD

Question 15

Finally performance anxiety what is used?

Answer 15

Beta blockers

–propranolol and nadolol