Anxiety

Anxiety Disorders

  • Anxiety disorders are characterized by an elevated or persistent stress response that is essential for survival but can lead to behavior changes and impairment of functions.

  • Anxiety levels can range from mild, moderate, severe, to panic.

Separation Anxiety Disorder

  • Description: Excessive fear or anxiety when separated from an individual to whom the client is emotionally attached.

  • Medication:

    • SSRIs (selective serotonin reuptake inhibitors): paroxetine, sertraline

    • Buspirone

  • Category:

    • SSRIs: Increases serotonin, modulates serotonin/dopamine to reduce anxiety.

  • Action:

    • SSRIs help to stabilize mood and anxiety by increasing serotonin levels in the brain.

  • Side Effects:

    • SSRIs: nausea, sexual dysfunction, weight gain

    • Buspirone: dizziness, nausea, headache

  • Patient Education:

    • SSRIs should be taken daily; full effect may take 4–6 weeks.

    • Buspirone is not PRN (as needed); full effect in 2–4 weeks; avoid grapefruit juice; do not stop medications suddenly.

Specific Phobias

  • Description: Irrational fear of a certain object or situation; specific clinical names are used to refer to different specific phobias.

  • Medication:

    • SSRIs: paroxetine, fluoxetine

    • Short-term benzodiazepines: alprazolam, lorazepam for acute anxiety

  • Category:

    • SSRIs: Increases serotonin;

    • Benzodiazepines: Increases GABA for rapid calming.

  • Action:

    • SSRIs modulate mood; benzodiazepines provide immediate relief by increasing GABA activity.

  • Side Effects:

    • Benzodiazepines: sedation, dizziness, dependence risk

    • SSRIs: gastrointestinal upset, insomnia.

  • Patient Education:

    • Use benzodiazepines only in the short term; avoid alcohol/CNS depressants; taper slowly if used long-term; combine with exposure therapy for best outcomes.

Agoraphobia

  • Description: Intense fear of places or situations where escape may be difficult.

  • Medication:

    • SSRIs: sertraline, fluoxetine

    • SNRIs (serotonin-norepinephrine reuptake inhibitors): venlafaxine

  • Category:

    • SSRIs and SNRIs help reduce panic and fear response by raising serotonin and norepinephrine levels.

  • Action:

    • Both SSRIs and SNRIs work to normalize neurotransmitter levels affecting anxiety.

  • Side Effects:

    • SSRIs/SNRIs: nausea, sexual dysfunction, increased sweating, insomnia.

  • Patient Education:

    • Take daily; effects build over weeks; do not stop abruptly; symptoms may worsen in the first 1–2 weeks before improvement.

Panic Disorder

  • Description: Characterized by recurrent panic attacks associated with palpitations, shortness of breath (SOB), chest pain, fear of dying, and constant worry about future attacks.

  • Medication:

    • SSRIs: paroxetine, sertraline

    • SNRIs: venlafaxine

    • Benzodiazepines: alprazolam, clonazepam for short-term use

  • Category:

    • SSRIs/SNRIs normalize serotonin levels; benzodiazepines provide rapid GABA-mediated relief.

  • Action:

    • SSRIs and SNRIs are used for long-term efficacy while benzodiazepines control acute panic symptoms.

  • Side Effects:

    • Benzodiazepines: sedation, potential for dependence

    • SSRIs/SNRIs: gastrointestinal upset, insomnia, sexual dysfunction.

  • Patient Education:

    • Benzodiazepines are for short-term use only; avoid alcohol; taper slowly; SSRIs/SNRIs may take weeks to have an effect.

Social Anxiety Disorder

  • Description: Excessive fear of social situations or performance contexts.

  • Medication:

    • SSRIs: paroxetine, sertraline

    • Propranolol (as needed for performance anxiety)

  • Category:

    • SSRIs stabilize serotonin; propranolol blocks adrenergic symptoms associated with anxiety during performance situations.

  • Action:

    • SSRIs enhance mood regulation, while propranolol reduces physiological symptoms of anxiety.

  • Side Effects:

    • SSRIs may cause gastrointestinal upset, sexual dysfunction.

    • Propranolol: bradycardia, hypotension, fatigue.

  • Patient Education:

    • Take propranolol 30–60 minutes before events; monitor blood pressure (BP) and heart rate (HR); do not stop SSRIs abruptly; report any worsening of depression or suicidal ideations.

Generalized Anxiety Disorder

  • Description: Characterized by uncontrollable and excessive worry lasting for at least 6 months.

  • Medication:

    • Buspirone

    • SSRIs: escitalopram, paroxetine

    • SNRIs: duloxetine, venlafaxine

  • Category:

    • Buspirone modulates serotonin/dopamine levels; SSRIs/SNRIs increase serotonin and norepinephrine.

  • Action:

    • Medications work synergistically to lower anxiety levels.

  • Side Effects:

    • Buspirone: dizziness, headache

    • SSRIs/SNRIs: nausea, insomnia, sexual dysfunction.

  • Patient Education:

    • Buspirone should be taken daily (not PRN); it takes 2–4 weeks to become fully effective; avoid grapefruit juice and St. John's Wort; taper SSRIs/SNRIs gradually; monitor for worsening anxiety at the beginning of treatment.

Obsessive-Compulsive Disorder (OCD)

  • Description: Intrusive thoughts (obsessions) accompanied by compulsive behaviors aimed at controlling these thoughts, such as repetitive cleaning or hand washing.

  • Medication:

    • SSRIs: fluoxetine, sertraline, fluvoxamine, paroxetine

    • Clomipramine (TCA)

  • Category:

    • SSRIs and TCAs raise serotonin levels to decrease obsessions and compulsions.

  • Action:

    • These medications stabilize mood and reduce compulsive behaviors.

  • Side Effects:

    • SSRIs: gastrointestinal upset, sexual dysfunction

    • Clomipramine: dry mouth, constipation, orthostatic hypotension.

  • Patient Education:

    • Medications should be taken daily; improvements may take 4–6 weeks or longer; do not discontinue abruptly; rise slowly when taking TCAs; recommend combining medication with cognitive-behavioral therapy (CBT) and exposure-response prevention techniques.

Hoarding Disorder

  • Description: Difficulty parting with possessions leading to extreme stress and functional impairments.

  • Medication:

    • SSRIs: paroxetine, fluoxetine

    • SNRIs: venlafaxine

  • Category:

    • SSRIs and SNRIs increase serotonin and norepinephrine, which help to reduce the compulsive need to save items.

  • Action:

    • Medications assist in regulating compulsive behavior.

  • Side Effects:

    • SSRIs/SNRIs: nausea, weight change, sexual dysfunction.

  • Patient Education:

    • Combining medication with therapy is most effective; do not stop medications abruptly; expect gradual therapeutic benefits.

Body Dysmorphic Disorder

  • Description: Preoccupation with perceived flaws or defects in physical appearance.

  • Medication:

    • SSRIs: fluoxetine, sertraline, escitalopram

    • Clomipramine

  • Category:

    • SSRIs increase serotonin levels, which help to reduce obsessive thoughts about appearance.

  • Action:

    • Medications work by alleviating the distress associated with body shape and appearance preoccupations.

  • Side Effects:

    • SSRIs: insomnia, gastrointestinal upset, sexual dysfunction

    • Clomipramine: anticholinergic effects, orthostatic hypotension.

  • Patient Education:

    • Medications should be taken daily; full effects can take 4–6 weeks; avoid mixing with alcohol; report any worsening mood or increase in suicidal thoughts.