Introduction. Pathophysiology of Anxiety Disorder
- Anxiety causes fear, insomnia, chronic pain, premonition, difficulty concentrating, the effectiveness of selective serotonin reuptake inhibitors (SSRIs), and more.
- The key point – sympathoadrenal, is associated with hypothalamic-pituitary-adrenal hyperreactivity.
- An increase in the concentration of ACTH and cortisol (Anxiety disorder).
- Anxiety decreases the brain-derived neurotrophic factor (BDNF).
Anxiety Disorder Treatment
- Treatment should not be self-administered
- The disorder regulatory effect on neurotransmitter systems, mainly serotonin (Anxiety disorder).
- Together with the norepinephrine and dopamine systems, the concentration of ACTH and cortisol provides an adequate emotional response to the body.
- Usually, 9-12 months of therapy is required to achieve complete remission
- The appointment of medicines begins with half the starting dose with a gradual increase in dosage after a week to the standard dose
Definitions of the Two Drug (medication) Classes used for Anxiety Disorder
- Drugs of selective serotonin reuptake inhibitors (SSRIs) help in anxiety treatment (Anxiety disorder).
- SSRIs have a pathogenetic therapeutic focus.
- Tranquilizers: maximum two weeks at the start of therapy.
- Prescribing tranquilizers is warranted for a maximum of 2 weeks when initiating SSRI treatment to avoid increased anxiety during the first week of SSRIs (Anxiety disorder).
- Medicines prescribed by a doctor.
Discussion of Medications
- Examples of SSRIs: citalopram (Celexa), fluoxetine (Prozac).
- Celexa stimulates synaptogenesis processes, restoring autophagy signals, and improving tissue immunoregulation with inhibition of immunogenic cytotoxicity of macrophages (Citalopram).
- An analog is Prozac, the mechanism of action in the central nervous system, which block the reverse neuronal uptake of serotonin selectively (Fluoxetine).
- Examples of tranquilizers: alprazolam (Xanax), clonazepam (Klonopin).
- Xanax has a sedative, central muscle relaxant, anticonvulsant, hypnotic, anxiolytic, effect. It reduces the impact of motor, vegetative, emotive and helps the body in falling asleep (Alprazolam).
- The anxiolytic effect of Klonopin is obtained as a result of the impact on the amygdala complex of the limbic system (Clonazepam). It is manifested in decreased fear, emotional stress, weakening and general anxiety.
Pharmacokinetics, Pharmacodynamics & Pregnancy/Lactation of Celexa
- Celexa dissolves in the liver.
- The action of the drug occurs because of central inhibition of serotonin reuptake.
- Celexa has a strong effect on the heart and gastrointestinal tract, thus requires for ECG and/or monitoring of electrolytes.
- Approved for use during pregnancy and lactation.
- It has side effects include poor feeding, colic, and unusual drowsiness, irritability, or restlessness in a minimal number of children.
Pharmacokinetics, Pharmacodynamics, & Pregnancy/Lactation of Prozac
- Absorbed from the gastrointestinal tract.
- Delays the reverse capture of serotonin.
- Monitoring is required.
- Approved for use during pregnancy and lactation.
- It increases the risk of genetic heart defects in the fetus, premature birth, and weight loss in a baby (Fluoxetine).
Pregnancy/Lactation during treatment for SSRIs
- Approved for use during pregnancy and lactation.
- It increases the risk of genetic heart defects in the fetus.
- Medicines may cause premature birth.
- In addition, weight loss in a baby is often.
- Passes into milk, so may affect the baby.
Pregnancy/Lactation during treatment for Tranquilizers
- Pregnancy and lactation are contraindicated.
- Easily crosses the placenta.
- Exceeds the concentration of diazepam in maternal blood.
- Increases the incidence of birth defects in children.
- Passes into milk, so may affect the baby.
Safety/Monitoring of Medications
- Monitoring is required at any stage of the disease.
- The medicine is prescribed by a doctor.
- Additional medications are carried out if necessary.
- Stop taking medications only on doctor’s orders.
- Completely individual dosage.
Pharmacokinetics, Pharmacodynamics of Xanax
- Absorbed from the gastrointestinal tract.
- Binds γ-aminobutyric acid (GABA) type A receptors (GABA AR).
- Completely individual dosage, therefore, requires monitoring and consultation with a doctor.
- Alprazolam has a harmful effect on the fetus and raises the possibility of congenital malformations when used in the first three months of pregnancy, thus, prohibited during pregnancy (Alprazolam).
- May cause drowsiness in newborns.
- Makes breastfeeding difficult.
Pharmacokinetics, Pharmacodynamic of Klonopin
- Plasma protein binding.
- The activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system.
- Completely individual dosage, therefore, requires monitoring and consultation with a doctor.
- Pregnancy and lactation are contraindicated.
Contraindications of the 4 Medications Discussed Earlier
- Each drug has its characteristics and contraindications, so one needs to consult a doctor.
- General contraindications include allergy, heart problems, problems with the gastrointestinal tract.
- Tranquilizers are prohibited if a person has glaucoma and diseases of the respiratory system.
- Long-term use is not justified because of the possibility of drug dependence.
- In addition, after the abolition of drugs in this group, the return of painful symptoms occurs since the main pathophysiological mechanisms associated with impaired serotonin mediation are not resolved.
Conclusions
- Anxiety disorder has different treatments.
- It requires individual treatment.
- Any drug must be prescribed by a doctor.
- The drugs are taken only under the supervision of the attending physician.
- One should always be aware of side effects and contraindications.
References
Alprazolam. WebMD. (n.d.).
Anxiety disorder treatment & medications. WebMD. (n.d.).
Citalopram. NHS. (n.d.).
Clonazepam. NHS. (n.d.).
Fluoxetine. NHS. (n.d.).