generalized anxiety disorder (GAD)

Panic disorder (PD)

Social Anxiety Disorder (SAD)

Obsessive Compulsive disorder (OCD)

Post Traumatic Stress Disorder (PTSD)

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Anxiety disorders are primarily treated with SSRIs, SNRIs or tricyclic antidepressants.

Drug interaction potential. Prescribers tend to use the newer agents that have less drug interactions and smaller dosing ranges.

Hydroxyzine (Vistaril) is occasionally used for short - term anxiety. This is a sedating antihistamine, and works by sedating the patient, rather than treating any underlying cause. It should not be used long term.

Pregabalin (Lyrica) is sometimes used for anxiety, and can be especially useful if a patient has neuropathic pain. It is scheduled C-V since it is slightly euphoric - which can have a calming effect.

Propranolol (Inderal) is used to reduce symptoms of stage fright, or performance anxiety (tremor, tachycardia). Use caution since CNS effects (confusion, dizziness) may be present.

Buspirone (Buspar) is an option for anxiety for patients who do not respond to antidepressants or in a patient at risk of abuse with benzodiazepines, or in addition to other therapy. It is a commonly used agent.

Benzodiazepine (BZD) are often used for anxiety symptoms. They provide fast relief for acute symptoms.

short - term situations in which axiety is acute and can cause extreme stress, prevent proper sleep, and disrupt life. This is could be the recent death of a loved one, an earthquake, a moter vehicle accident, or other stressfull situations. In such cases they re used less than 1 - 2 weeks and can be discontinued.

BZDs cover up, but do not treat, the causes of anxiety, and, in most cases, should not be used long - term.

CIV potential for abuse

Physiological dependence and tolerance develoop with chronic use

L-O-T (lorazepam, oxazepam, and temazepam): these are considered less potentially harmful for elderly or with liver impairment since they are metabolized to inactive compounds (glucunoids).

Chlordiazepoxide (Librium) and Diazepam (Valium)

Additive effects with sedating drugs, including most pain medicines, muscle relaxants, antihistamine, the antidepressant mirtazapine (Remeron), trazodone, alcohol, among others

Only if used for insomnia: This medication should be taken before bedtime (for anxiety is taken prn)

5-HT1 partial agonist: Not Controlled, NO Abuse or Physiological Potential - this, rather than a higher efficacy over BZDs, makes buspirone a widely used agent.

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decrease dose with erythromycin, diltiazem, verapamil; consider dose reduction with any 3A4 inhibitor.

3A4 inducers, including rifampin, may require an increase in the buspirone dose.

Buspirone comes in a Dividose tablet designed to make dose adjustments easy. Each table is scored and can be broken accurately on the score lines into thirds. It snaps into pieces with finger pressure.