anxiety
Table of Contents
anxiety disorders, panic attacks, hyperventilation
see also:
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
self-help programs
- 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
pharmacotherapy for anxiety
pre-Rx counselling
- 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
1st line Rx
- 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
other agents
- venlafaxine - most anxiety disorders except OCD
- duloxetine - generalised anxiety disorder
- anti-psychotic medications such as quetiapine
anxiety.txt · Last modified: 2013/12/23 06:30 by 127.0.0.1