Anxiety Treatment Overview

Anxiety Treatment

• Acute Anxiety: Benzodiazepines
• Chronic Anxiety: SSRIs (sertraline, citalopram, escitalopram, fluoxetine), and Propranolol (alleviates physical symptoms).

Benzodiazepines

• Hepatic Coma: Long-acting benzodiazepines (diazepam, alprazolam, chlordiazepoxide hydrochloride, clobazam) can induce hepatic coma, especially in long-term use.

• Short-acting preferred: Short-acting benzodiazepines (lorazepam and oxazepam) are often preferred in patients with impaired liver function or age. Warning: Risk of withdrawal symptoms higher with short-acting.

• Paradoxical Effects: Benzodiazepines can sometimes cause paradoxical effects, including aggression, hostility, excessive talkativeness, and excitation.

• Sedation: Benzodiazepines can increase sedation when combined with alcohol or other CNS depressants. Avoid if driving or operating machinery (some, like Clonazepam, Lorazepam, Diazepam, Flunitrazepam, and Temazepam are on a legal driving limit list)

• Enzyme Considerations: Some drugs can interact with the metabolism of benzodiazepines

Benzodiazepine Withdrawal

• Withdrawal symptoms: Anxiety, sweating, weight loss, tremors, loss of appetite.

• Tapering: Tapering is essential to avoid withdrawal symptoms and should be done carefully. (gradually decrease the dose daily).

• Dosage reduction: Convert all medications to a once-nightly dose of diazepam. Gradually reduce by 1-2 mg (or 1/10th of a larger initial dosage) every 2-4 weeks. ONLY reduce further if withdrawal symptoms have resolved. Final dose reductions should be done very very incrementally (0.5mg).

• Overdose Treatment: Flumazenil is used to treat benzodiazepine overdose.

This quiz covers various treatments for anxiety, focusing on both acute and chronic conditions. Specific medications like benzodiazepines and SSRIs are discussed, along with their effects, preferences, and risks associated with usage. Test your knowledge on how different treatments impact anxiety management.