Pharm Anxiety Disorders

Definition of an anxiety disorder

Anxiety that becomes excessive, causes irrational behavior, impairs functioning

What are the DSM5 diagnostic criteria for GAD

A. Excessive anxiety and worry occurring more days than not for at least 6 months about a variety of events

B. The individual finds it difficult to control the worry

C. Anxiety and worry are associated with at least three symptoms below for 6 months:

Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

D. Sx cause clinically significant distress or impairment of function

E. Sx not attributable to physiological effects of a substance or other medical condition

Antidepressants used in Tx of anxiety:

SSRIs (Paroxetine, Citalopram, Excitalopram/Lexapro, Sertraline/Zoloft) or SNRIs (Venlafaxine, Duloxetine)

Buspirinone MOA, S.E., risks

MOA: unclear, but has high affinity for 5HT1 and 5HT2 receptors w/o affecting GABA

S.E.: dizziness, drowsiness, nausea, excitement

Risks: can precipitate serotonin syndrome when used with an MAO or SSRI

Hydroxyzine MOA, uses, onset/duration, S.E., rare skin condition associated

MOA: H1 antagonist/antihistamine but also has activity at muscarinic serotonergic 5HT2 and dopaminergic receptors in brain = anxiolytic effects

Uses: used as an adjuvant while awaiting maintenance meds to work

Onset: 15-30 mins Duration: 4-6 hours

S.E.: drowsiness, cognitive dysfunction, QT prolongation, anticholinergic

Rarely causes generalized exathematous pustulosis

Benzodiazepines MOA, S.E., uses

MOA: enhances effect of GABA at its receptor, increases neural inhibition

S.E.: sedation, muscle-relaxant effects, withdrawal, dependency

Uses: SHORT TERM management of acute anxiety (risk of dependency, avoid if PMH of substance use disorder)

Lack of efficacy for depression treatment

Benzodiazepines examples

Diazepam, Clonazepam, Lorazepam (Ativan), Alprazolam (Xanax), Temazepan, Midazolam

First and second line pharm for panic disorder

1st: SSRIs as pts commonly have depression as well

2nd: SNRI Venlafaxine

Definition of social anxiety disorder (aka social phobia/SAD)

Unreasonable fear of embarrassment in social situations. It’s a chronic disorder beginning in adolescence

1st line pharm for social anxiety disorder. 2nd line?

SSRI (paroxetine, sertraline, escitalopram) or SNRI (venlafaxine)

2nd line are BB: propanolol, atenolol for episodic anxiety (like before public speaking)