Pharmacological treatment for Anxiety

Medications are a common treatment for anxiety disorders in adults, and research supports their efficiency. Anxiolytic drugs have been shown to reverse specific abnormalities in the neurotransmitter system of anxious people. Benzodiazepines (BZs) have been shown to be effective in treating adults with panic disorders, agoraphobia with panic, social phobia, and generalized anxiety disorder. Required dosage varies considerably across individuals and recommended practice is to start with a low dose and build up until a therapeutic effect is achieved, thus avoiding unnecessary toxicity and side effects. Physical dependence on BZs is concern, and discontinuation of BZ treatment can be associated with a rebound in symptoms, so a gradual fading and augmentation of the medication with psychological treatments is recommended. Tricyclic antidepressants (TCAs, especially imipramine  and clomipramine) adn especially monomine oxidase inhibitors have been shown effective with panic disorder and social phobia. The advantage of these medications are that they can also produce an improvement in comorbid depressive symptoms. However, both of these antidepressants have significant side effects. Thus they are rarely a first choice for the treatment of primary anxiety. The selective serotonin reuptake inhibitors are widely used as antidepressants and have been shown to have potential for the treatment of panic disorder, social phobia, obsessive compulsive disorder, and post-traumatic stress disorder. However, little information is available about the long-term efficacy of these agents and the side effects, which can include agitation, insomnia, gastrointestinal problems, and sexual dysfunctions.

A number of important clinical issues have been identified regarding medication treatments for anxiety disorders. The long-term outcomes and effects of medication are not clear and the therapeutic benefits once medication has been discontinued remain dubious.  Most clinicians, therefore, consider a combination of drug and cognitive behavioural treatment to be optimal for handling anxiety disorders.

With regard to children, there is a lack of well controlled and well conducted research studies into psychopharmacological interventions, and there is little support for their use as sole treatments for anxiety disorders with younger people. BZs, which have received the most empirical support and are most commonly prescribed for children and adolescents with anxiety disorders, they are tolerated by most children with minimal side effects, although these can include unsteady gait, blurred/double vision, reduced mental acuity , sedation, slurred speech, tremor, drowsiness, and irritability . BZs are comparatively safe in overdose, but the risks associated with tolerance and dependence in children are unknown. Studies of the efficacy of TCAs with anxious children have focused on separation anxiety and school refusal and have produced conflicting results. Only one of four published studies has provided support for the efficacy of TCAs in the treatment of separation anxiety. However, one of the three negative studies used an arguably sub-therapeutic medication dosage while the remaining two had small sample sizes. The most frequent side effects of TCAs include blurred vision, sedation, lightheadedness, dry mouth, urinary retention, and constipation.  Overdosage can result in severe medical complications. There is some evidence that buspirone may be effective in the treatment of generalized anxiety, and further controlled trials are merited, especially given it’s lack of major side effects, its limited potential for abuse, and its low probability of producing withdrawal symptoms following cessation. Fluoxentine (prozac) has shown promise in the treatment of childhood obsessive compulsive disorder and generalized anxiety in children. In one study,81% of the children given fluoxetine showed moderate to marked improvement in their anxiety symptoms with few side effects.

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