Anxiolytics

Anxiolytics

Unwanted effects

ataxia
drowsiness
Falls
confused thinking
amnesia
potentiating effects of alcohol.
increased risk of dementia (use of benzodiazepines for more than 3 months)
Paradoxical behavioral disinhibition
respiratory depression (benzodiazepines and clozapine)


Dependence and withdrawal
The frequency depends on the drug and the dosage, and has been estimated to be up to 50% of patients who are long-term users.

Dependence and withdrawal

Withdrawal symptoms generally begin within:
2–3 days of stopping a short-acting benzodiazepine,
7 days of stopping a long-acting one.
The symptoms generally last for 3–10 days.

Withdrawal symptoms seem to be more frequent after taking drugs with a short half-life than after taking those with a long one

Dependence and withdrawal

If benzodiazepines have been taken for a long time, it is best to withdraw them gradually over a period of several weeks.
Dependence and withdrawal

Benzodiazepines do have the advantage of becoming quickly effective. Therefore current advice is that they should be administered on a short-term basis only (not more than 4 weeks) to help a patient to cope with functionally disabling anxiety while other treatment measures are instituted.
Dependence and withdrawal

Antidepressant drugs used for anxiety

TCAsGADs, panic disorder, and PTSDs
SSRIsanxiety disorders, obsessive–compulsive disorder
SNRIs(venlafaxine and duloxetine) anxiety disorder
MAOI treatment can also be used in treatment-resistant patients

Differences in therapeutic profile between antidepressant & benzodiazepines

Disadvantages
The time of onset of effect is much slower (particularly in panic disorder),
there may be an exacerbation of symptoms early in treatment.
sudden cessation of treatment can cause abstinence symptoms.


Differences in therapeutic profile between antidepressant & benzodiazepines
Advantages
therapeutic effect of antidepressants is as least as great as that of benzodiazepines,
less likely to produce cognitive impairment
not associated with tolerance and dependence

Antipsychotic drugs used for anxiety

Conventional antipsychotic drugs have sometimes been prescribed in low doses for their anxiolytic effects.

Antipsychotic drugs used for anxiety

patients with persistent anxiety who have become dependent on other drugs,
those with aggressive personalities who respond badly to the disinhibiting effects of benzodiazepines.

Antipsychotic drugs used for anxiety

However, even low-dose antipsychotic treatment, if maintained, is not free from the risk of tardive dyskinesia.

Antipsychotic drugs used for anxiety

Newer antipsychotic drugs, such as quetiapine, may also possess
anxiolytic effects when given either as a sole treatment or as
augmentation treatment


Beta-adrenoceptor antagonists that are used for anxiety
These drugs relieve some of the autonomic symptoms of anxiety, such as tachycardia, by a peripheral effect.

Beta-adrenoceptor antagonists that are used for anxiety

They are best reserved for anxious patients whose main symptom is palpitation or tremor, particularly in social situations.

Beta-adrenoceptor antagonists that are used for anxiety

An appropriate drug is propranolol in a dose of 20–40 mg three times a day.

Pregabalin

derivative of the anticonvulsant drug, gabapentin.

Pregabalin has

anticonvulsant
analgesic properties.
anxiolytic (for the treatment of GADs).

Pregabalin

doses of 150–600 mg
is at least as efficacious as other agents used to treat GADs


Pregabalin
The most common adverse effects are:
somnolence
dizziness (potentiate central sedative effect of benzodiazepines and alcohol).
increased appetite,
mood changes,
confusion,
ataxia,
tremor,
memory impairment.
visual disturbances (vision loss, blurred vision, changes of visual acuity.
discontinuation symptoms (insomnia, headache, nausea, diarrhoea, anxiety, sweating, and dizziness).