Drugs for anxiety

Question 1

Tx for Generalized anxiety disorder?

Answer 1

• Antidepressants (first line)
• replaced benzodiazepines d/t:
  1. s.e profile
  2. no risk for dependency
  3. efficacy in common comorbid conditions incl depression, PD, OCD, and SAD.

Question 2

what are the preferred antidepressants for GAD?

Answer 2

1. venlafaxine

2. SSRIs

Question 3

Benzodiazepines

use rec’d in GAD?

Answer 3

• short-term relief is needed.
• adjunct during initation of antidepressant therapy or to improve sleep.
• initial adjunct when starting SSRI titrate. taper off when SSRI reaches effective dose.

Question 4

Buspirone

uses?

Answer 4

• second line.
• no immediate anxiety relief.
• gradual onset
• does not cause abuse potential, withdrawal rxns, or potentiate EtOH and sedative-hypnotic effects.

Question 5

what are some GAD alternatives?

Answer 5

1. hydroxyzine

2. pregabalin

Question 6

Panic disorder tx?

Answer 6

1. antidepressants

- SSRIs are DOC

Question 7

Benzodiazepines

Uses in Panic Disorder?

Answer 7

1. concomitantly c antidepressants, esp in early tx, or as monotherapy to acutely reduce panic sx’s.
2. not preferred long term
3. used when pts fail several antidepressant trials.

alprazolam = cause rebound anxiety, assoc c a withdrawal syndrome, incl seizures.

Question 8

Social anxiety disorder tx?

Answer 8

SSRIs (DOC)

onset 8-12wks

Question 9

Obsessive compulsive disorder tx?

Answer 9

1. clomipramine
2. fluoxetine
3. fluvoxamine
4. paroxetine
5. sertraline

for highly anxious OCD, add benzodiazepine or antipsychotic

Question 10

PTSD tx?

Answer 10

1. SSRIs (first line)
2. other antidepressants
3. Sertraline (long term)
4. paroxetine (acute tx)

Question 11

Performance anxiety tx?

Answer 11

1. beta blockers c lipophilicity
   - propranolol
   - nadolol

limited d/t hypotension

Question 12

define anxiety?

Answer 12

• normal response to stressful or fearful circumstances.
• adapt to or manage the stressful/threatening situation
• can become excessive -> irrational thinking or behavior, impairs a person’s functioning is considered an anxiety disorder.