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Anxiety Medication Essay

In: Science

Submitted By imperiallight
Words 570
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1st Line - SSRI’s

Fluoxetine has a long half-life, making it a good choice in marginally compliant patients. Good research base.

Citalopram, quicker onset, shorter half life.

Sertraline – Most cost effective, NICE reccomends
Higher therapeutic dosage in depression.
Initial: 50 mg PO qDay. May increase by 25 mg at 1-week intervals; not to exceed 200 mg qDay
Risk of activation with SSRI – anxiety / suicidality
Long >1 week rate of effect
Some of the more common adverse events associated with SSRI and SNRI use include nausea, sexual dysfunction, agitation, weight gain, and insomnia.
When stopped abruptly, most SSRIs can produce a discontinuation syndrome characterized by dizziness, insomnia a
Reluctantly use Tricyclics:
Sedating antidepressants such as mirtazapine/paroxetine and other TCAs e.g Imipramine are usually prescribed only at night before bed to help improve sleep. They have less of an activating effect.
TCAS can cause BP/dizziness, drowsiness, dry mouth, and weight gain.

Consider Pregabilin if the above medications are contraindicated.

2nd Line – SNRI Venlafaxine

Bicyclic - potent inhibitors of serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake. Higher therapeutic window.

* 75 mg/day PO divided q8-12hr initially; may be increased by ≤75 mg/day not faster than every 4 days * Moderate: Up to 225 mg/day PO divided q8-12hr

Risk in overdose/cardiac/HTN
Initiate in secondary care

3rd Line +/- Antipsychotic

Dopaminergic blockade and regulation of receptor sensitivity.
Olanzapine, Aripirazole

Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia.

MAOIs can react with SSRIs to produce a serious condition called “serotonin syndrome,” which can…...

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