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Anxiety and Psychopharmacology

Anxiety and Psychopharmacology. Anxiety and Depression. Are Coexisting in many clients Sometimes it is difficult to differentiate anxiety from agitation and bipolar mixed episodes in depressed clients. Anxiety and Depression.

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Anxiety and Psychopharmacology

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  1. Anxiety and Psychopharmacology

  2. Anxiety and Depression • Are Coexisting in many clients • Sometimes it is difficult to differentiate anxiety from agitation and bipolar mixed episodes in depressed clients

  3. Anxiety and Depression • 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

  4. GAD • 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

  5. GAD-Antidepressants or Anxiolytics • 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)

  6. Anxiety and the Physical Body • 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

  7. Benzodiazepines • 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

  8. Benzos • Balance risks with benefits and consider other medications and therapeutic approaches • Stress reduction • Exercise • Healthy dies • Appropriate work situation • Management of interpersonal life

  9. Use as “Safety Net” • 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

  10. BuSpar (Buspirone) • 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?

  11. Clonidine & Beta Blockers • 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

  12. From your reading • List medical disorders associated with anxiety • List drugs that can cause anxiety

  13. How do we decide whether to recommend a med eval for anxious clients?

  14. What about the insomnia that coexists with anxiety (and other forms of MI) • 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

  15. Sedative hypnotics for insomnia • 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

  16. Atypical Benzodiazepines • 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.

  17. Antihistamines • 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

  18. Benzos • Rapid onset, short acting • Halcion • Delayed onset, intermediate acting • Temazepam/Restoril • Rapid Onset, Long acting • Flurazepam/Dalmane • Quazepam/Doral

  19. Sedating Antidepressants • TCAs (a variety will target both depression and insomnia when given at bedtime) • Trazodone/Desyrel (in lower doses than for depression) • Mirtazapine/Remeron

  20. OTC • Contain one or more of three ingredients • 1) anticholinergic agent-scopolamine • Side effects-dry mouth, blurred vision, constipation, some confusion or memory problems particularly in the elderly • 2) antihistamine • Side effects same as for 1 • 3)mild pain reliever • Watch for Drug interactions, check with physician

  21. Herbs • No evaluations of safety • No consensus on dose efficacy • Side effects are not well studied • Example: Kava Kava is now known to cause liver damage (possibly dose dependent) • May interact with prescriptions or other OTCs • Example: St Johns Wort thins the blood and if taken with aspirin, may can fatal complications

  22. How do we decide whether or not to recommend a med Eval for Insomnia?

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