2. Anxiety
• Unpleasant state of tension, apprehension or uneasiness
that seems to arise from an unknown source.
• It can be a part of any disorder other than Anxiety spectrum
disorders.
• It can be found in normal being like performance related anxiety.
4. • Unpleasant state of tension, apprehension or uneasiness that arise
from an unknown source.
5.
6. • Majority of prescriptions are written by primary care
physicians.
• Psychiatrists write less than 20% of the prescriptions
• Most anxious patients never see psychiatrists.
7. Insomnia VS Anxiety
• Almost any sedative or antianxiety drug can be used at a low dose in
the daytime for anxiety and at a similar or higher dose for difficulty in
sleeping.
8. MOA
• Benzodiazepine binding sites on aminobutyric
acid A (GABA-A) receptors.
• Mostly mild CNS depressants
• Control the symptoms of anxiety, produce a restful state of mind
without interfering with normal mental or physical functions.
9. BASIC PRINCIPLES
• Base your choice on the availability of drug, pharmaco-economics,
side effect profile etc.
• Discuss with the patient likely outcomes, such as gradual relief from
symptoms
• Prescribe low dose that is likely to be effective.
• Withdraw gradually
14. Buspirone
• MOA:
Selective agonistic action on 5HT-1A receptor
Weak D2 blocking action – no antipsychotic or
extrapyramidal S/E
Site of action:
• Dorsal raphe seretoninergic neurones
• 5-10mg OD-TDS
15. Azapirones
• Advantages:
No sedation
No tolerance or physical
dependence
No abuse liability
Less psychomotor
impairment
Does not potentiate the
effect of other CNS drugs
• Disadvantages
Slow onset of action
not suitable for acute
anxiety
Requires thrice daily admin
16. SSRI in Anxiety
• Preferred in chronic anxiety states
• Started in low dose
• Slow onset of action
• Started along with BZD
17. Beta blockers
oPropranolol :reduce the symptoms of anxiety
oThey do not affect the psychological symptoms (worry ,tension,
anxiety)
oUsed for performance/situational anxiety
oDose: 20-40mg 2hr before the performance
18. Clonidine
• Alpha adrenergic agonist
• 3-7ug/kg/day
• Longer onset of action
• Sedation most common side effect
• Other SE- dry mouth, headache, paradoxical worsening, hypotension
and rebound hypertension
• R/o CVS disorders and taper while discontinuing
19. Others
• Quetiapine & other Antipsychotics in low dose
• Pregabaline
• Gabapentine
• L-Theaine
• Opipramol
• Psychotherapy and relaxation exercise
• Yoga and Mindfulness
• Daily physical exercise
