Anxiety and AntiAnxiety Medications

1
Anxiety and Anti-Anxiety Medications

• A Presentation for Psychopharmacology
• Milagros Evardone
• March 22, 2006

2
What is anxiety?

• Anxiety has been defined as an unpleasant
  emotional state or reaction that can be
  distinguished from others, such as anger or
  grief, by a unique combination of experiential
  qualities and physiological changes.
• An anxiety state consists of feelings of
  tension, apprehension, nervousness, and worry,
  and activation of the autonomic nervous system.
• Physiological manifestations generally include
  increased blood pressure, rapid heart rate,
  sweating, dryness of mouth, vertigo,
  irregularities in breathing, and muscular
  skeletal disturbances.

3
Normal VS. AbnormalAnxiety

• Anxiety is normal in any situation in which an
  immediate danger may result in physical harm.
• Anxiety is also a normal reaction to
  social-evaluative situations that pose threats to
  self-esteem or psychological well-being.
• Neurotic, clinical, or abnormal anxiety occurs
  in situations in which there is no real physical
  or psychological danger, or when the emotional
  reaction is disproportionate in intensity to the
  actual danger.

4
More Anxiety Definitions

• State anxiety A temporal cross-section in the
  emotional stream of life of a person, consisting
  of tension, apprehension, nervousness, and worry
  and activation (arousal) of the autonomic nervous
  system.
• Trait anxiety Relatively stable individual
  differences in anxiety-proneness, that is,
  differences between individuals in the tendency
  to perceive stressful situations as dangerous or
  threatening.

5
Clinical Disorders (DSM-IV)

• Panic disorder (PD) with or without agoraphobia
• Agoraphobia without history of PD
• Specific phobia
• Social phobia
• Obsessive-compulsive disorder (OCD)
• Posttraumatic stress disorder (PTSD)
• Acute stress disorder
• Generalized anxiety disorder (GAD)
• Anxiety disorder due to a general medical
  condition
• Substance-induced anxiety disorder
• Anxiety disorder NOS
• (For more information on diagnostic criteria and
  symptoms, refer to www.adaa.org and
  www.nimh.nih.gov/healthinformation/anxietymenu.cfm
  )

6
Explanations of Anxiety

• Psychological theories
• Freuds theory
• Cognitive
• Behavioral
• Biological theories
• Genetics
• Neural and neuroendocrine pathways involved in
  bodys normal stress response (fight or flight)
• Specific action by neurotransmitters and other
  neurochemicals

7
Neural Pathways Fight or Flight Response
Stressful Event
Cortex
Amygdala
Locus coeruleus
Hypothalamus
Sympathetic nervous system
Pituitary
Adrenal medulla
Adrenal cortex
Thyroid
Cortisol
Thyroxin
Adrenaline
Noradrenaline
8
Neuroendocrine Pathways (Detailed)
Amygdala
Hypothalamus
Parabrachial Nucleus
Periaquaductal Gray Area
Locus Coeruleus
Freeze, Avoid, Escape
(NE) Inc. alertness
Inc. respiration
CRF
TRH
SNS
Pituitary
Pituitary
ACTH
TSH
Adrenal Medulla
NE Through out the body
Adrenal Cortex
Thyroid Gland
Adrenaline
NE
Cortisol
T3 T4
9
Gamma-aminobutyric acid (GABA)

• GABA plays a role in activating chloride ion
  channels.
• Chloride ions (- charge) come into the cell and
  hyperpolarize the cell.
• This results in calming of overall brain
  excitation.
• (see diagram on p. 103 of Preston et al., 2005)

10
Serotonin

• Excitability of locus coeruleus (LC) also
  mediated by serotonin.
• Global decrease in serotonin thought to affect LC
  causing it to become disinhibited (i.e., more
  sensitive to activation)
• Serotonin also hypothesized to inhibit cellular
  reactivity in the amygdala.

11
Etiology of Clinical Disorders

• Primarily psychogenic
• GAD
• Acute stress disorder
• Specific phobias
• Agoraphobia

• Evidence for biological factors
• Social phobia
• Anxiety associated with general medical condition
• Panic disorder
• - noradrenergic hypothesis

12
Anti-anxiety Medications (i.e., anxiolytics)

• Benzodiazepines
• Atypical benzodiazepines
• Busipirone
• Antidepressants
• Antihistamines
• Beta blockers
• Clonidine
• Tiagabine

13
Benzodiazepines

• First drug of this type (Librium) created in
  1957.
• Mechanism Interact with benzodiazepine receptors
  and enhance the effect of GABA, increasing influx
  of chloride ions.
• Rapid effect within 30 minutes Therapeutic
  effect within 1 week
• Relatively short half-lives (see table on p. 190
  of Preston et al., 2005)
• 75 of users show moderate to marked improvement
  in symptoms
• Mild and transient side effects
• May become physically addictive and lead to
  withdrawal symptoms if discontinued abruptly.

14
Atypical Benzodiazepines

• Benzodiazepine derivatives used as hypnotics.
• Estazolam (ProSom)
• Quazepam (Doral)
• Zolpidem (Ambien)
• Zaleplon (Sonata)
• Mechanism Similar to benzodiazepines.

15
Busipirone

• Type azapirone drug
• Mechanism Acts on 5-HT 1A receptor thought to
  balance serotonin levels by lowering them in
  anxious persons. However, exact mechanism
  unknown.
• Delayed effect Therapeutic effect within one or
  two weeks.
• Appears particularly effective in treatment of
  GAD.
• Not addictive.
• Does not produce psychomotor impairment and does
  not interact with other CNS depressants.

16
Antidepressants

• Monoamine oxidase inhibitors (MAO) created in mid
  1950s
• MAO inhibitors not frequently prescribed today
  due to interaction with tyramine and the
  associated food restrictions.
• Low therapeutic index.
• See table on page 167 of Preston et al., 2005 for
  drug examples.

• Cyclic drugs
• - Most prescribed from 1950s 1980s
• - Mechanism Blocking reuptake of
  norepinephrine, acetylcholine, and serotonin.
• - Low therapeutic index.
• - See table on page 167 of Preston et al., 2005
  for drug examples.

17
Antidepressants (cont)

• Selective serotonin reuptake inhibitors (SSRIs)
• - Introduced in 1980s
• - More potent than cyclic drugs.
• - Long half-life.
• - Bigger therapeutic index and fewer side
  effects.
• - See table on page 167 of Preston et al., 2005
  for drug examples.

18
Other Anti-Anxiety Agents

• Antihistamines
• Mechanism Block histamine receptors in the CNS
  associated with anxiety and agitation.
• Rapid effect within 20-30 min.
• May cause drowsiness, impaired performance, and
  develop tolerance to anxiolytic effects.

• Beta Blockers
• Mechanism Block the effects of norepinephrine at
  the receptor in the brain and the peripheral
  nervous system.
• Originally developed to treat hypertension.
• Effective at reducing physical symptoms of
  anxiety (i.e., rapid heart beat, muscle tension,
  dry mouth).

19
Other Anti-Anxiety Agents

• Clonidine
• Mechanism alpha-2 adrenergic agonist
  presynaptic inhibitor of norepinephrine release
• Originally used to treat hypertension

• Tiagabine
• Mechanism GABA reuptake inhibitor
• Originally an anticonvulsant
• May be useful in treating PTSD and PD.

20
From www.healthyplace.com/Communities/Anxiety/trea
tment/medications.asp
21
(No Transcript)
22
(No Transcript)