Article
Background:
The primary anxiety disorders
Generalised Anxiety Disorder
Panic disorder
Social Anxiety Disorder
Pharmacological Treatments for Anxiety
| Drug class | Examples | Mode of action |
| Selective serotonin reuptake inhibitors (SSRIs) | Escitalopram, paroxetine, sertraline, fluoxetine | Inhibit serotonin reuptake, leading to increased serotonergic transmission |
| Serotonin-norepinephrine reuptake inhibitors (SNRIs) | Venlafaxine, duloxetine | |
| Anticonvulsants | Pregabalin, gabapentin | Bind to alpha-2-delta subunit of voltage-gated calcium channels |
| Benzodiazepines (BDZs) | Diazepam, lorazepam, alprazolam, clonazepam | Allosteric modulation of gamma-aminobutyric acid (GABA) receptors |
| Tricyclic antidepressants (TCAs) | Imipramine, clomipramine, nortriptyline | Inhibit serotonin and norepinephrine reuptake, modulate specific 5-hydroxytryptamine (5-HT) receptors |
| Miscellaneous antidepressants | Bupropion, mirtazapine | Various mechanisms, including SRI, 5-HT receptor modulation, and others |
| Antihistamines | Hydroxyzine | Histamine blocking |
| Monoamine oxidase inhibitors (MAOIs) | Phenelzine, tranylcypromine | Inhibit the enzyme monoamine oxidase, leading to increased levels of neurotransmitters such as serotonin and dopamine |
Treatment protocol for anxiety
| First line | Second line | Third line | Fourth line | |
| Generalised anxiety disorder | SSRIs & SNRIs | Buspirone, Pregabalin, BDZs | TCAs | 2G-antipsychotics and miscellaneous antidepressants |
| Panic disorder | HPB (clonazepam) | 2G-antipsychotics MAOIs, and VPAs | ||
| Social anxiety disorder | SSRIs & SNRIs + Beta-blocker | Short-acting BDZs (lorazepam) | HPB (clonazepam) | Anticonvulsants and MAOIs |
Conclusion:
The article intends to provide a pragmatic stepwise approach for pharmacological management of anxiety disorders.
Abbreviations:
SNRI: Serotonin-norepinephrine reuptake inhibitor; SSRI: Selective serotonin reuptake inhibitor; TCA: Tricyclic antidepressant; BZD: Benzodiazepine; HPB: high-potency BZDs; MAOIs: Monoamine oxidase inhibitors; VPA: valproic acid
Reference:
Melaragno AJ. Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance. Focus. 2021;19(2):145-60.
Articles
Combination Treatment Of SSRI And BZD For Depression Associated With Anxiety
Dar SA, Bhat BA, Jan MM. Addition of benzodiazepines to selective serotonin reuptake inhibitors to optimize treatment of depression: a hospital based study. Int J Res Med Sci. 2018;6(6):2081-5.
Impact of anxiety on Quality of Life
Chattopadhyay K, Singh AP. Anxiety and its impact on quality of life among urban elderly population in India: An exploratory study. Indian J Res Homoeopathy. 2016;10:133-41.
Clinical Practice Guidelines For Geriatric Anxiety Disorders
Subramanyam AA, Kedare J, Singh OP, et al. Clinical practice guidelines for Geriatric Anxiety Disorders. Indian J Psychiatry. 2018;60(Suppl 3):S371-S382.
Case study
The Role of SSRI and BZD Combination Therapy in Anxiety Disorders
A 34-year-old female patient presented with symptoms of anxiety. The patient had a 10-month history of anxiety symptoms.
The Role of SSRI and BZD Combination Therapy in Anxiety Disorder with Comorbid Depression
A 38-year-old male patient presented with symptoms of anxiety and comorbid depression.
Blog
Management of anxiety in emergency
Anxiety disorders, characterised primarily by intense and exaggerated anxiety without real threats, are frequently encountered in the general population.
Age-based prevalence and factors associated with anxiety disorder
Anxiety disorders (ADs) have a significant impact on individuals' quality of life and productivity, contributing to substantial economic losses at the national level.