Transcript Anxiety and Psychopharmacology

Anxiety and
Psychopharmacology
Anxiety and Depression
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Are Coexisting in many clients
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Sometimes it is difficult to
differentiate anxiety from
agitation and bipolar mixed
episodes in depressed clients
Anxiety and Depression
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Anxious Responders: Cls with
Depression and Anxiety who
improve with antidepressants by
eliminating depressed mood, but
who do not have complete
remission because they remain
worried/tense, have insomnia
and somatic symptoms and
generalized anxiety
GAD
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GAD unfortunately gets
overlooked as a “minor
disorder”, but nothing is further
from the truth for the sufferer.
Constant anxiety takes a toll on
quality of life and the physical
body. GAD tends to be chronic;
which is in conflict with the idea
of using benzodiazepines short
term
GAD-Antidepressants or
Anxiolytics
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First line: SSRIs especially
those that target ACH (Paxil); or
(Effexor XR) which has both anti
depressant and anxiolytic
properties
Benzos: Second line or
augmentation
TCAs can be used alone or as
augmentation (Remeron)
Anxiety and the Physical Body
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Anxiety can harm the physical body
causing IBS, migraines, muscle pain,
immune system issues, etc.
While Benzos are traditionally short
term tx, more physicians are seeing
that the anxiety can cause more
physical damage to the body then
the Benzos
Half life and Metabolism are
important in choosing drug
Benzodiazepines
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Work with GABA in the brain
Effect sleep cycles nonrestful
sleep
At least five receptor subtypes have
been identified, allowing for science
to try and make benzos more
selective in the future.
Have antianxiety, anticonvulsant,
muscle relaxant, and sedative
hypnotic actions
Benzos
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Balance risks with benefits and
consider other medications and
therapeutic approaches
Stress reduction
 Exercise
 Healthy dies
 Appropriate work situation
 Management of interpersonal life
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Use as “Safety Net”
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For clients with Panic Disorder,
Benzos provide fast relief and
can be effective as an
inoculation against anticipatory
anxiety if kept on hand (without
being taken)
Will discuss more in lecture on
OCD, Panic Disorder and PTSD
BuSpar (Buspirone)
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Pros: does not have interactions
with alcohol, lack of dependence
or withdrawal, can use with
previous substance abusers,
better tolerated by the elderly
Cons: Delay of onset
Would you use it for panic
attacks or GAD?
Clonidine & Beta Blockers
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NE blocker- so will lower blood
pressure
Stops tachycardia (rapid heart
beat), dilated pupils, sweating,
tremor
Not great for subjective and
emotional experience of anxiety
Not good choice for GAD
From your reading
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List medical disorders
associated with anxiety
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List drugs that can cause
anxiety
How do we decide whether to
recommend a med eval for
anxious clients?
What about the insomnia that
coexists with anxiety (and other
forms of MI)
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First assess if Insomnia is primary
concern or secondary to another
Psychiatric condition or medical
disorder
Assess if due to medication or D&A
Assess if due to sleep hygiene
However, often primary insomnia or
secondary (due to meds or disorder)
remains and must be treated
Sedative hypnotics for
insomnia
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Labels and Warnings suggest
use for only 3-4 months or 1 out
of 3 nights a week
However, long-term insomnia
can be chronic and need long
term tx
Continued use is recommended
to be reevaluated every few
months
Atypical Benzodiazepines
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For sleep problems
ProSom: rapid onset, medium half
life-less daytime sedation
 Ambien & Sonata: short acting-so
good for initial sleep issues, but
not middle of night awakening.
Does not effect sleep cycle.
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Antihistamines
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Often first line in inpatient
settings to reduce agitation,
while promoting sedation
Can be used for sleep problems
due to their sedating properties
Can build tolerance
Not good for GAD, due to
sedation
Benzos
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Rapid onset, short acting
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Delayed onset, intermediate
acting
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Halcion
Temazepam/Restoril
Rapid Onset, Long acting
Flurazepam/Dalmane
 Quazepam/Doral
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Sedating Antidepressants
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TCAs (a variety will target both
depression and insomnia when
given at bedtime)
Trazodone/Desyrel (in lower
doses than for depression)
 Mirtazapine/Remeron
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OTC
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Contain one or more of three
ingredients
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1) anticholinergic agent-scopolamine
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2) antihistamine
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Side effects-dry mouth, blurred vision,
constipation, some confusion or memory
problems particularly in the elderly
Side effects same as for 1
3)mild pain reliever
Watch for Drug interactions, check with
physician
Herbs
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No evaluations of safety
No consensus on dose efficacy
Side effects are not well studied
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Example: Kava Kava is now known to
cause liver damage (possibly dose
dependent)
May interact with prescriptions or
other OTCs
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Example: St Johns Wort thins the blood
and if taken with aspirin, may can fatal
complications
How do we decide whether or not
to recommend a med Eval for
Insomnia?