The Nervous System: Drugs for Anxiety and Sleep Disorders

Anxiety Disorders

1.Generalized Anxiety Disorder (GAD)
2. Panic Disorder
3. Phobias
4. Obsessive-Compulsive Disorder (OCD)
5. Post-Traumatic Stress Disorder (PTSD)

Anxiety ESSENTIALS OF DIAGNOSIS

1)Persistent excessive anxiety or chronic fear and associated
behavioral disturbances.

2) Somatic symptoms referable to the autonomic nervous system or to a specific organ system (e.g., dyspnea, palpitations, paresthesia).

3)Not limited to an adjustment disorder.

4)Not a result of physical disorders, other psychiatric conditions (e.g.,schizophrenia), or drug abuse (e.g., cocaine).

Insomnia

An inability to fall asleep and/or stay asleep.

The cause of insomnia is multifactorial and is commonly associated with anxiety disorders.

disorders associated with excessive daytime sleepiness:

narcolepsy,

obstructive sleep apnea (OSA),

and restless legs syndrome (RLS).

Commonly used classes of medications for insomnia include:

1. Benzodiazepines Melatonin
   2. Nonbenzodiazepine antianxiety drugs First generation
   antihistamines
   3. Antidepressants-SSRIs, TCAs
   4. Barbiturates

Medications for Anxiety

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs)

are first line pharmacotherapy treatment for anxiety and depression. SSRIs also effectively treat eating disorders, panic disorders, and obsessive-compulsive disorders.

Why are SSRI classified as selective serotonin reuptake inhibitors?

Drugs in this class do not affect the reuptake of norepinephrine or dopamine

SSRIs) Medicines:

1)Fluoxetine (Prozac; Sarafem; Prozac Weekly),
2)citalopram (Celexa)

3)escitalopram (Lexapro)

4) paroxetine (Paxil; Pexeva),
5)sertraline (Zoloft)

6) fluvoxamine (Luvox).

Benzodiazepines

are strong central nervous system depressants with significant abuse potential

Benzodiazepines should not be used….

as maintenance treatment for anxiety. In addition, benzodiazepines increase fall risk and should be used cautiously

Benzodiazepines enhance the activity of…

GABA.

They do not mimic GABA so there is a limit to the amount of CNS depression produced.

Benzodiazepines include

alprazolam, diazepam, clonazepam, and lorazepam

Significant issues OF Benzodiazepines

Tolerance, physical dependence, addiction, oral overdose, and IV toxicity