Unit 2- Anxiety Meds

Antidepressants: Treatment for Anxiety Disorders

 SSRIs and SNRIs

 SSRIs and SNRIs

 First line treatment for anxiety disorders –Generalized Anxiety Disorder (GAD), panic, social phobia as well as Obsessive Compulsive Disorder (OCD).

 Secondary benefit of treating co-occurring depressive disorders

 Preferable to the TCAs has fewer side effects, more rapid onset of action, and more effective.

How do antidepressants work in the body for treating anxiety?

Antidepressants work by increasing neurotransmitter concentrations in the brain.

What is the goal of drug therapy in treating anxiety?

The goal of this drug therapy is to increase the intrasynaptic availability of norepinephrine, serotonin, and dopamine. The increase in the neurotransmitter concentrations helps decrease anxiety.

How long does it take for antidepressants to become effective?

Generally require 2-4 weeks to become effective – may use another med such as a benzodiazepine for acute anxiety episodes during that time.

SSRIs- Effective For Sadness, Panic, Compulsions

• escitalopram (Lexapro),

• fluoxetine (Prozac),

• sertraline (Zoloft)

• paroxetine (Paxil),

• citalopram (Celexa),

SNRIs

• duloxetine (Cymbalta),

• venlafaxine (Effexor)           

Tricyclics

Second or third line use due to anticholinergic side effects, cardiovascular side effects, dangerous in overdose

Tricyclic Antidepressant for OCD

clomipramine (Anafranil)

Antianxiety/Anxiolytics Medications

 Non-Benzodiazepines

 Benzodiazepines

 Sedative/Hypnotics

 Antihistamines

Antianxiety/Anxiolytics Medications MOA

 Anxiolytics, sedatives and hypnotics are medicines that work on the central nervous system to relieve anxiety, aid sleep, or have a calming effect.

Non-Benzodiazepine Antianxiety

buspirone (Buspar)

buspirone (Buspar)

•  Used for Generalized Anxiety Disorder

• Chronic anxiety disorders may require long term maintenance with  *buspirone (BuSpar) to control symptoms

• Binds to serotonin and dopamine receptors

• No CNS depression

• No addiction potential documented compared to benzos

• Dosing 2 to 3X a day; not used “as needed”

• Takes 1-2 weeks for initial effect ,  4-6 weeks for full effect

buspirone (Buspar)- Side Effects

 Side effects may be dizziness, headache, lightheadedness

Buspirone (Buspar) is not a….

Benzodiazepine

Benzodiazepines- Long Day Always Call for Medication

CNS depressants –

• lorazepam (Ativan),

• diazepam (Valium),

• alprazolam (Xanax),

• chlordiazepoxide (Librium);

• *midazolam (Versed)

Benzodiazepines- MOA

 Used for short-term only treatment of Anxiety Disorders

 Enhance action of GABA receptors

 Have quick onset of action

Benzodiazepines- Nursing Considerations

 Tolerance, dependence, withdrawal are problems

 Nurse monitors for side effects of sedation, ataxia, decreased cognitive function

 Abruptly stopping may cause seizures

 Abrupt withdrawal can be potentially life threatening, result in seizures, withdrawal only under medical supervision.

 Instruct client to avoid alcohol, other CNS depressants and other meds without consulting HCP

Addiction Potential is High!!!!

Flumazenil (Romazicon)

used as a benzodiazepine antidote for overdose.

Sedative/Hypnotic Medications

  has a sleep induct effect:  

flurazepam (Dalmane);

triazolam (Halcion)

Sedative/Hypnotic Classification

Benzodiazepines- Contraindications

 Contraindicated in clients with acute narrow angle glaucoma; used very cautiously in older adults.

Benzodiazepines- side effects

 Side and adverse effects: 

• sedation, ataxia,

• dizziness, headaches,

• blurred vision, hypotension,

• constipation, urinary incontinence,

• paradoxical CNS excitement,

• behavior change.

Antihistamines

 diphenhydramine (Benadryl)

 hydroxyzine (Vistaril)

hydroxyzine hydrochloride (Atarax)

Antihistamines- MOA & Nursing Considerations

 Very sedating, work quickly

 No addiction potential

 Used short term for mild anxiety usually

Often seen used inpatient for anxiety and to help patient sleep

Antihistamines- side effects

dizziness, headache, sleepiness, dry mouth

Other meds

• Propranolol (Inderal)

• Clonidine (Catapres)

• Gabapentin (Neurontin)

Propranolol (Inderal)

 Beta adrenergic blocker used for panic disorder and social anxiety disorder, reduces physical responses, ie:  racing heart

Clonidine (Catapres)

Alpha 2 agonist, a blood pressure medication can reduce physical responses to anxiety

Gabapentin (Neurontin)

an anticonvulsant also used for anxiety

Guidelines for use of Antianxiety Agents

 Sedation potentiates falls, accidents 

 Cautious use in older adults, renal, liver problems

 Do not combine with other CNS depressants

 Alcohol and benzodiazepines are extremely dangerous mixed

 Do not stop benzodiazepine therapy abruptly, withdrawal syndrome and  withdrawal seizures