Drugs for Anxiety

Question 1

1st line for management of Chronic GAD?

why have they replaced Benzos?

Answer 1

Antidepressants
• good side effect profile
• no risk for dependency
• efficacy in common comorbid conditions including depression, PD, OCD and SAD.

Question 2

When can Benzo’s be used?

Answer 2

• Recommended for acute treatment of GAD when short-term relief is needed, as an adjunct during initiation of antidepressant therapy, or to improve sleep.

Question 3

2nd line agent for GAD

Answer 3

BUSPIRONE

2 weeks to work

Question 4

Alternate agents for GAD.

Answer 4

Hydroxyzine

Pregabalin

Question 5

why do you have to be careful when administering Alprazolam?

Answer 5

may cause rebound anxiety between doses and has been associated with a withdrawal syndrome, including seizures.

Question 6

OCD drugs?

what drugs should be used for highly anxious OCD patients?

Answer 6

• 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 7

PTSD
what are the first line?
what drugs are used for acute tx and longterm tx?

Answer 7

• 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 8

Performance anxiety tx?

Answer 8

• β-blockers with high lipophilicity (propranolol and nadolol), are used for performance anxiety.
• Use is limited by adverse effects such as hypotension.