Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Wayne Judge
Initial Post: Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder
COLLAPSE
Introduction

Generalized anxiety disorder (GAD) is classified in the Diagnostic and Statistical Manual DSM 5 under anxiety disorders and defined as uncontrollable worrying about activities or events lasting six months or longer, commonly with depression as a comorbidity (Ansara, 2020; Rosenthal & Burchum, 2021). This discussion looks at selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) approved by the FDA and are first-line treatments for GAD, which also help to decrease depression (Rosenthal & Burchum, 2021). The pharmacokinetic action of SSRIs and SNRIs is that both block serotonin at the neurons, resulting in reabsorption in the brain. However, SNRIs also inhibit absorption of norepinephrine, which also results in reabsorption by the brain. (Villines, 2020). There are also several non-pharmacologic first-line therapies used for the treatment of GAD, such as relaxation therapy and cognitive behavioral therapy, that can be used alone or in conjunction with pharmacologic treatment (Ansara, 2020). Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

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Reflecting on Observations of Treatment for Generalized Anxiety Disorder

Reflecting on observations of treatment for GAD while working at the Northwest Detention Center (a federal immigration detention facility), the focused patient was diagnosed with GAD with comorbidity of mild depression. Said patient was a healthy 36-year-old Caucasian male recently incarcerated with no known prior medical history and had no risk of alcohol or illicit drug use. This patient was prescribed Paroxetine (Paxil) for a diagnosis of GAD. The initial dosing of Paroxetine, 20 milligrams PO daily with 10 milligrams weekly interval increases, was given until 40 milligrams a day was reached. Although 50% of patients with GAD will not respond to first-line treatment (Ansara, 2020), 40 milligrams for this patient proved therapeutic. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Comparison of Medication used to Treat Generalized Anxiety Disorder

Four antidepressants are approved by the Food and Drug Administration (FDA) for treating GAD; Paxil is one of those four medications due to its efficacy in treating anxiety and depression (Strawn et al., 2018). Other medication classes, such as benzodiazepines like Alprazolam (Xanax) or a non-benzodiazepine non-barbiturate Anxiolytic like Buspirone (Buspar), are also effective in treating GAD. While working in federal immigration facilities, this RN has learned; that when diagnosing and prescribing medication for patients with GAD, it is important to look at multiple factors influencing the patient life. Factors such as differential medical diagnosis, current medications, environment, behavior, diet, age, and gender, as well as ethnicity and cultural beliefs, as all these elements will influence how well a medication will work for your patient and whether said patient will adhere to treatment. These considerations hold true for those patients not incarcerated as well. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Benzodiazepines Metabolized by Cytochrome CYP3A4 into metabolites and rapidly absorbed are indicated for acute episodes and are not recommended for long-term treatment of GAD due to the potential of addiction. Alprazolam (Xanax) is rapidly absorbed with a half-life is 11.2 hours and reaches peak plasma concentration around 1 to 2 hours (Ansara, 2020; George & Tripp, 2022). Monitoring a patient’s cardiovascular and respiratory status and the metabolic panel should occur while prescribing this medication to patients. This medication should be avoided in use with a patient with pulmonary disease. Certain types of drugs can affect this medication, i.e., macrolide antibiotics, some antidepressants, some seizure medication, and St. Johns Wort. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Buspirone (Buspar) is a partial agonist on Serotonin 5HT1a as well as a weak antagonist on dopamine autoreceptors D2 and has no effect on GABA receptors. This medication is contraindicated in patients with a history of hypertension, not recommended for use in patients on monoamine oxidase inhibitors (MAOI) and patients receiving reversible MAOI treatment. Although this medication is well tolerated in pediatrics, adolescents, and adults, it is not FDA-approved for pediatric use (Strawn et al., 2018; Wilson & Tripp, 2021). Monitoring should be frequent after starting treatment with this medication and therapeutic effects should be reached at around 3 to 4 weeks. Plasma concentration should be monitored as well and alcohol use will increase CNS effects. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Paroxetine (Paxil) is high protein bound and has a significant first-pass metabolism through the CYPP2D6 system, where it is affected by many polymorphisms and is excreted through the urine (Shrestha et al., 2021). Paroxetine also inhibits its own metabolism; thus, potential doubling of plasma concentration may be experienced after dosage increases. This medication has a few absolute contraindications; pimozide could result in inducing cardiac arrhythmia, concurrent use of MAOIs causing serotonin syndrome, and use with thioridazine also inducing cardiac arrhythmia. This medication is also not recommended for use with tricyclic antidepressants. Moreover, although it was a male patient, this medication was prescribed and not female as an FYI; it should not be prescribed to pregnant or breastfeeding women. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

Conclusion

The clinical treatment provided to the 36-year-old Caucasian male patient diagnosed with GAD and mild depression this RN observed and described in this paper was prescribed Paxil due to the environment, formulary constrictions, and medication actions. Paxil was chosen for the patient at a 20mg initial dose with 10mg weekly increases until therapeutic results were achieved. For this patient, 40 milligrams proved to be effective. Paxil is a first-line treatment option and was chosen due to its efficacy in treating both GAD and depression and is one of only four antidepressants approved by the FDA to treat GAD. Benzodiazepines and Buspirone were not chosen due to Benzodiazepine’s addictive properties, and Buspirone was not indicated due to lack of access to alcohol or illicit drugs. Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay

References

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https://www.ncbi.nlm.nih.gov/books/NBK531477/ Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Essay