anxiety disorders, panic attacks, hyperventilation

introduction

all people have periods of anxiety
it may become troublesome and regarded as a disorder if it becomes persistent, or is out of proportion to what would be expected and interferes with functioning.
personality style may be a critical cause of anxiety and in these cases, patients are unlikely to respond to drug Rx alone.
most people can be managed with self-help programs although some may warrant referral to a clinical psychologist, and some may require pharmacologic assistance after pre-treatment counselling.
substance abuse including alcohol use tends to increase anxiety disorders
do not forget to exclude agitated depression and suicidality as a differential diagnosis

Anxiety Online - an Aust. Govt funded website developed by Swinburne Uni
This Way Up - an initiative of the Sydney St Vincent's Hospital Clinical Research Unit
eCentre Clinic - developed by Macquarie University

most agents will have initial mild adverse effects such as nausea, headache and dizziness, and anxious patients may interpret these as indicating they may have a serious medical problem
it is thus important to spend time beforehand to discuss these issues and the fact, it will take some 4-6 weeks before benefit starts, and to start on a low dose for a few days to a week
allow at least 4-6 weeks for the minimum recommended dose to work before increasing to higher doses
most patients should be considered for Rx duration of around 1 year
if inadequate response after good duration of Rx, consider changing to another SSRI
consider adding cognitive behavioural Rx after some symptomatic improvement has occurred

historically benzodiazepines were used as 1st line anxiolytics have their use has some disadvantages such as cognitive impairment, dependence and anxiety-producing withdrawal period which preclude their utility as 1st line agents
current 1st line agents now should be SSRI/SNRI antidepressants
- Rx dose may vary according to disorder, for example:
  - fluoxetine:
    - usual dose 20-40mg/d
    - panic disorder may require up to 60mg/d
    - OCD may require up to 80mg/d
a very short course of benzodiazepines for only a few days to a week may be indicated to get patients through a particularly stressful period