Pharmacological Treatments For Generalized Anxiety Disorder Essay

Erin Lewis
Week Eight Discussion-Main Post-Erin Lewis
COLLAPSE
Week Eight Discussion-General Anxiety Disorder and Anxiolytic Treatments

Generalized anxiety disorder (GAD) is a mental health disorder that produces fear and worry with constant feelings of being overwhelmed. It is characterized by excessive, persistent, and unrealistic

worry about everyday things. It is the most common mental health disorder among adults and is present in almost twenty percent of the population (Munir & Takov, 2022). Pharmacological Treatments For Generalized Anxiety Disorder Essay

Treatment options for GAD include pharmacological therapy, psychological therapy, or a combination of both. Evidence shows that a greater amount of success comes from pharmacological therapy in

comparison to psychological therapy. Despite this, up to 25% of patients treated for GAD do not have a response to the treatment (Slee et al., 2021). Medications used to treat GAD include benzodiazepines,

antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), the atypical antipsychotic quetiapine, and buspirone (Munir & Takov,

2022).

The first type of medication used to effectively treat anxiety were benzodiazepines. However, due to its safety profile, they are no longer a first-line medication. First-line medications for GAD are SSRIs

and SNRIs. They have shown to be generally well tolerated and to be effective in up to 50% of patients (Munir & Takov, 2022). Quetiapine has been shown to be effective at reducing anxiety symptoms but

had a lower rate of tolerance among patients due to side effects (Slee et al., 2021). Buspirone, a non-benzodiazepine antianxiety medication, has also been used to treat GAD but is recommended as adjunct or

second line therapy (Munir & Takov, 2022). Pharmacological Treatments For Generalized Anxiety Disorder Essay

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Pharmacodynamic and pharmacokinetics of medications can impact the patient’s ability to tolerate treatment depending on the treatment response and its impacts on the patient’s quality of life. This

plays a large role in what medications are selected by providers for their patients. Sertraline, a SSRI, is an example of a well-tolerated medication with minimal impact on quality of life. Sertraline is not

affected by the time of day that it is taken. It can, however, be affected by meals with up to a 25% increase in peak concentrations if taken with food. Despite this, no difference has been found in the area under

the curve (AUC) when fasting and non-fasting groups were compared. There is some thought that the elderly may have increased concentrations when compared to younger patients, however, this may be due

to body weight and not age. Because of this, elderly patients should be started at a lower dose. A history of liver failure is to be considered as it significantly increases half-life and AUC. Sertraline is

hepatically cleared and should be dose adjusted based on degree of liver failure or avoided in severe liver failure. Patients with gastric bypass also need decreased dosing as absorption was found to be

increased post procedure. Patients with renal impairment do not need to have their dose adjusted (Huddart et al., 2021). The immediate side effects of SSRIs are mostly reported to be gastrointestinal upset.

Patients using SSRIs long-term have other side effects leading to intolerance. These include sexual dysfunction, weight gain, and sleep disturbances. Patients should be counseled in regard to a withdrawal

period with abrupt cessation. The symptoms associated with abrupt stoppage start about one week after cessation and last approximately three weeks. These symptoms include dizziness, nausea, lethargy,

headache, anxiety, and agitation (Ferguson, 2001). Pharmacological Treatments For Generalized Anxiety Disorder Essay

Quetiapine is recommended to be used only if first line or second line therapy fails, or as an adjunct therapy along with a SSRI. Providers that decide to add this medication to their patient’s regimen

need to be aware that it does carry a risk of weight gain and diabetes (Katzman, 2014). Quetiapine’s absorption is minimally affected by food and the pharmacokinetics are unchanged by smoking. Though it

has less sleep disturbance than SSRIs, it does cause sedation which is not well tolerated by many. Along with fatigue, extrapyramidal symptoms lead to intolerance and cessation by many who are prescribed

quetiapine. It is not affected by renal dysfunction, but patients with liver failure need dose adjustment or avoidance. Elderly patients will require a decreased dose compared to standard adult dosing (Maneeton

et al., 2016).

Though benzodiazepines are no longer recommended as first line treatment for anxiety, they can still be used for acute anxiety symptoms. This type of usage has been found to be well tolerated in

patients who are generally compliant with their overall treatment regimen. There does still remain a concern for misuse, dependence, and increased safety concerns with concomitant use of opioids or alcohol Pharmacological Treatments For Generalized Anxiety Disorder Essay

(Slee et al., 2021). Side effects include sedation, fatigue, ataxia, slurred speech, memory impairment, and weakness. They also carry a risk of withdrawal reactions with abrupt cessation with this risk

increasing with patients who have a longer history of use. Elderly patients who take benzodiazepines are at a much greater risk of falls and fractures. Patients with renal disease do not need the dose adjusted,

however, patients with liver failure do need the dose decreased secondary to hepatic clearance (Slee et al., 2021).

Buspirone, a non-benzodiazepine anxiolytic, does not carry with it a concern for dependency as bezodiazepines do, nor does it cause sedation or develop tolerance. It does, however, have a longer onset

of action and is not beneficial for acute attacks as traditional benzodiazepines have been (Munir & Takov, 2022). It is used as a second-line agent after SSRIs have failed or as an adjunct to SSRIs to decrease

sexual dysfunction associated with SSRI usage. Taking this medication with food does increase absorption but will decrease first pass metabolism. Because of this, patients need to take it consistently either

with or without food. The does does need adjustment for pateints with renal failure and it is not recommended for use in patients with liver failure. The most commonly reported side effect is dizziness;

however, patients may also report confusion, blurred vision, tremor and weakness (Wilson & Tripp, 2022).

References

Huddart, P., Hicks, K., Ramsey, L., Strawn, J., Smith, D., Babilonia, M., Altman, R., & Klein, T. (2020). PharmGKB summary: Sertraline pathway, pharmacokinetics. Pharmacogenet Genomics, Pharmacological Treatments For Generalized Anxiety Disorder Essay

30(2), 26-33. https://doi.org/10.1097/FPC.0000000000000392

Ferguson, J. (2001). SSRI antidepressant medications: Adverse effects and tolerability. Primary Care Companion to the Journal of Clinical Psychiatry, 3(1). https://doi.org/10.4088/pcc.v03n0105

Katzman, M., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group. (2014). Canadian clinical practice guidelines for the management

of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14. https://doi.org/10.1186/1471-244X-14-S1-S1

Maneeton, N., Maneeton, B., Woottiluk, P., Likhitsathian, S., Sittajit, S., Boonyanaruthee, V., & Srisurapanont, M. (2016). Quetiapine monotherapy in acute treatment of generealized anxiety disorder:

A systemic review and meta-analysis of randomized controlled trials. Drug Design Development and Therapy, 10. https://doi.org/10.2147/DDDT.S89485

Munir, S. & Takov, V. (2022). Generalized anxiety disorder. StatPearls. Retrieved July 18, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK441870/

Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Fremantle, N. (2019). Pharmacological treatments for generalized anxiety disorder: A systematic review and network meta-analysis. Lancet,

393(10173). https://doi.org/10.1016/S0140-6736(18)31793-8

Wilson, T. & Tripp, J. (2022). Buspirone. StatPearls. Retrieved July 18, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK53147 Pharmacological Treatments For Generalized Anxiety Disorder Essay