Chapter 3: Pharmacological Tx of Anxiety Disorders

Question 1

Timline of medications used to treat anxiety

Answer 1

1. Barbiturates developed in early 1900’s
   . phenobarbital- 1914
   . barbiturates used 1915-1960 as anxiolytics, sedatives, hypnotics, anti convulsants, and anesthetics.
   . these were lethal in overdose
   . 1950’s- led to less sedating meds and less lethal
2. benzodiazapines developed (valium, librium) in the 1960’s; MINOR tranquilizers
3. phenothiazine- MAJOR tranquilizers
4. SSRIs- late 1980’s- Prozac
5. Atypical antipsychologist- seroquel, risperdal, and abilify
6. antiepileptic drugs- neurontin, lyrica, lamictal, topomax
7. antihypertensive medications- propranolol, prazosin

Question 2

Treatment of the Neonate

Answer 2

1. Untreted maternal anxiety sets the stage for reduced developmental scores in the newborn, slowed mental development, and potential future anxiety and depression.
2. depression in preschool is correlated with untreatmed depression and anxiety in pregnant mother
   a. abnormal development of neurons within the hippocampus of th enewborn.
3. The developing fetal brain stress hormones, vitamin deficiences, and omega 3 fatty deficiency negatively affect neurogenesis and migration programming.
4. NO BENZOS during the first trimester.
5. PAXIL- can cause cardiac anomalies.
6. Lamictal hs the greatest safety ration of available anticonvulsants during pregnancy.

7.

Question 3

Treatment of Preschool Anxiety

Answer 3

1. Anxiety disorders in preschool periods (305years of age) are common
2. social anxiety, generalized anxiety , separation anxiety and specific fears
3. aggressive treatment is necessary
4. cognitive therapies are helpful for non-PTSD and non-OCD anxiety
5. fluoxetine is first choice
6. no benzodiazapines
7. maybe no medication for PTSD
8. Any medication that acts to increase dopamine (ritalin) may worsen anxiety
   a. add anxiolytic rather than discontinue ritalin

Question 4

Treatment in school age children and adolescents

Answer 4

1. CBT and SSRIs effective for GAD, separation anxiety, and social phobia
   a. combination therapy is the most effective
2. ocD is the 4th most common psychiatric disorder in adolescents (2-3%)
   a. about 30% of adolescents will be resistant t SSRI plus CBT and augmenting with atypical might be necessary (seroqul, abilify).
3. PTSD is common in children and adolescents
   a. do not use cognitive inhibitiors

Question 5

Treatment of anxiety in adults

Answer 5

1. benzodiazapines- used for 50 years
   a. fast acting
   b. cognitive impairments
   c. withdrawal issues
   d. better used as a sedative than an anxiolytic.
   e. long half lives of benzos can mean that someone is never truly drug free.
2. duloxetine may be more effective than venlafaxine
3. can try anticonvulsants; gabapentine and pregabalin (lyrica) for GAD and social anxiety disorder.
4. atypical antipsychotics

Question 6

Treatment of anxiety in the elderly

Answer 6

1. Do not use benzos
   a. adverse cognitive effects
   b. increased falls
   c. impacts driving
   d. negative effect when drinking alcohol
   e. withdrawaal is difficult and can cause seizures and insomnia and rebound anxiety and agitation.
2. antidepressants
   a. drug of choice fo anxiety in the elderly
   b. SSRIs can inhibit the activity of multiple drig-metabolizing enzyme systems.
   c. SSRIs cam omjobot brealdpwm pf p[opd ama;gesocs )o/e/. ,etjadpme_/
   d. duloxetine effective in treating anxiety with comorbid depression and low back pain.
   e. mirtazapine- good for comorbid insomnia, anxiety, and depression
3. atypical antipsychotics
   a. relieve anxiety, confusion, pacing, agitation, wandering, restlessness, aggression, non-complicance, psychosis, depressin, sleep issues.