Anxiety/ADHD

• Anxiety


  An uncomfortable state with psychologic and physical components
• Psychological component of anxiety

  • Fear, apprehension, dread and uneasiness
• Physical component of anxiety

  • Tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, and shortness of breath
• Anxiety disorders are among the most common psychiatric illnesses
• Anxiety can be appropriate in some situations
• Anxiety disorders treatment


  Psychotherapy, drug therapy, or both. A combination is more effective than either alone.
• Drug classes used to treat anxiety disorders

  • Serotonergic reuptake inhibitors (SRIs) which includes SSRIs and SNRIs
  • Benzodiazepines
• Generalized anxiety disorder (GAD)


  Characterized by uncontrollable worrying that lasts six months or longer
• Symptoms of GAD


  • Vigilance, tension, apprehension, poor concentration, difficulty falling or staying asleep, somatic manifestations such as trembling, muscle tension, restlessness and signs of autonomic hyperactivity such as palpitations, tachycardia, sweating, clammy, cold hands
• Generalized anxiety disorder is not situational anxiety
• Generalized anxiety disorder is the least likely to remit
• Non-drug approaches for managing GAD

  • Supportive therapy
  • Cognitive behavioral therapy
  • Biofeedback
  • Relaxation training
• Antidepressants approved for GAD

  • Venlafaxine
  • Duloxetine
  • Paroxetine
  • Escitalopram
• Benzodiazepines


  First-choice drugs for acute anxiety. Benefits derive from enhancing responses to GABA, an inhibitory neurotransmitter.
• Benzodiazepines


  • Onset of benefits is immediate, and the margin of safety is high
  • Principal side effects are sedation and psychomotor slowing
• Benzodiazepines should be used with caution in patients known to abuse alcohol or other psychoactive substances due to their abuse potential
• Long-term use of benzodiazepines carries a risk for physical dependence
• Withdrawal symptoms from benzodiazepines include panic, paranoia, and delirium
• Benzodiazepines should be tapered gradually over a period of several months to minimize withdrawal symptoms
• Benzodiazepines approved for GAD

  • Alprazolam
  • Lorazepam
  • Chlordiazepoxide
  • Clorazepate
  • Diazepam
  • Oxazepam
• Buspirone


  An anxiolytic drug that differs significantly from the benzodiazepines. It is not a CNS depressant.
• Buspirone


  • It has no abuse potential and does not intensify the effects of other CNS depressants
  • The anxiolytic effects are delayed
  • cannot be prescribed as a PRN
• Buspirone has been taken for as long as a year with no reduction in benefit
• If switching from a benzo to buspirone, the benzo must be tapered slowly
• Buspirone has been used for up to 1 year without signs of tolerance, physical dependence, or psychological dependence

  no cross-tolerance with sedative-hyptonics

  no potential for abuse
• Panic disorder (PD)


  Characterized by recurrent, intensely uncomfortable episodes known as panic attacks
• Symptoms of a panic attack

  • Palpitations, pounding heart, racing heartbeat; Sweating; Trembling or shaking; Sensation of shortness of breath or smothering; Feeling of choking; Chest pain or discomfort; Nausea or abdominal distress; Feeling dizzy, unsteady, lightheaded, or faint; Chills or heat sensations; Paresthesias (numbness or tingling sensations);Derealization (feelings of unreality) or depersonalization (feeling detached from oneself);Fear of losing control or going crazy; and Fear of dying
• Panic symptoms reach a peak in a few minutes and then dissipate within 30 minutes
• The incidence of PD in women is 2 to 3 times the incidence in men
• Onset of PD usually occurs in the late teens or early 20s
• The underlying cause of PD is unknown
• Treatment for PD


  Cognitive behavioral therapy, drug therapy, or a combination which is more effective than either alone

  drug therapy suppress panic attacks

  CBT more comfortable in situations
• Antidepressants used to treat PD

  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs
• Because of tolerability, SSRIs are first line drugs for PD
• SSRIs approved for PD

  • Fluoxetine
  • Paroxetine
  • Sertraline
• Obsessive compulsive disorder (OCD)


  A potentially disabling condition that's characterized by persistent obsessions and compulsions that cause marked distress and they consume at least one hour a day and significantly interfere with daily living
• Treatment for OCD


  Behavioral therapy is more important than drug therapy. Both behavioral therapy and drug together are more effective than either alone.
• SSRIs approved for OCD, what other two meds have shown effective?

  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline

  Citalopram and Escitalopram
• Clomipramine is the only approved tricyclic for OCD, but it is less tolerated due to the side effects
• Social anxiety disorder (SAD)

  Characterized by an intense irrational fear that one will be scrutinized by others or do something that is embarrassing and humiliating