pharmacology of Anxiety

1. Anxiety
Heena Parveen,
M.Pharmacy (Pharmacology),
CP&PT.
Presented by:

2. Definition:
 Anxiety is a feeling of apprehension or fear. The
source of this uneasiness is not always known or
recognized, which can add to the distress you
feel.
 Anxiety disorders are a group of psychiatric
conditions that involve excessive anxiety.
ANXIETY

3. OBJECTIVES
 Natural response and a necessary warning adaptation in humans.
 Pathologic disorder when it is excessive and uncontrollable,
requires no specific external stimulus, and manifests with a wide
range of physical and affective symptoms as well as changes in
behavior and cognition disorder.

4. OBJECTIVES
• Generalized Anxiety Disorder (GAD)
• Social Phobia
• Panic Disorder
• Agoraphobia
• Specific Phobia
• Post-Traumatic Stress Disorder (PTSD)
• Obsessive-Compulsive Disorder (OCD)
TYPES OF ANXIETY

5. OBJECTIVES
• Generalized Anxiety Disorder (GAD)
– Is characterized by at least 6 months of persistent and excessive anxiety and
worry.
• Social Phobia
– Is characterized by clinically significant anxiety provoked by exposure to
certain types of social or performance situations, often leading to avoidance
behaviors.
• Panic Disorder
– Severe feelings of doom that cause both mental and physical symptoms that
can be so intense that some people become hospitalized, worried that
something is dangerously wrong with their health.
– characterized by two things:
• Panic attacks, Fear of getting panic attacks.
TYPES OF ANXIETY

6. OBJECTIVES
• Agoraphobia
– Is anxiety about, or avoidance of, places or situations from which escape might
might be difficult (or embarrassing) or in which help may not be available in
the event of having a Panic Attack or panic-like symptoms
• Specific Phobia
– People with a specific phobia experience extreme anxiety and fear if exposed
to a particular feared object or situation. Common phobias include fear of
flying, spiders and other animals, heights or small spaces.
• Post-Traumatic Stress Disorder (PTSD)
– Is characterized by the re-experiencing of an extremely traumatic event
accompanied by symptoms of increased arousal and by avoidance of stimuli
associated with the trauma.
TYPES OF ANXIETY

7. OBJECTIVES
• Obsessive-Compulsive Disorder (OCD)
Compulsions and obsessions are similar, but exhibit themselves in
different ways:
• Obsessions:
– thought based
– Causes mark anxiety or distressed
• Compulsions:
– behavior based.
– Neutralizes anxiety
TYPES OF ANXIETY

8. ETIOLOGY
 Emotion
 Biology
 Environment
 Behaviour
 Cognition

9. EPIDEMIOLOGY
UNITED STATES STATISTICS
• Social phobia is the most common anxiety disorder;
• It has an early age of onset— age 11 years -50% & by age 20 years -80%
According to: Epidemiological Catchment Area (ECA) study
and National Comorbidity Survey (NCS) study
• 2.3-2.7% for panic disorder
• 4.1-6.6% for generalized anxiety disorder
• 2.3-2.6% for OCD
• 1-9.3% for PTSD
• 2.6-13.3% for social phobia.
Further, the NCS reported the following lifetime (and 30-day) prevalence estimates:
6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple (ie, specific) phobia, and
13.3% (and 4.5%) for social phobia

10. EPIDEMIOLOGY
International statistics
• Cross-national study - prevalence of panic disorder found lifetime prevalence rates
ranging from 0.4% in Taiwan to 2.9% in Italy.
• Cross-cultural study - prevalence of OCD found lifetime prevalence rates ranging
from 0.7% in Taiwan to 2.5% in Puerto Rico.
• In some Far East cultures, individuals with social phobia may develop fears of being
offensive to others rather than fears of being embarrassed.

11. PATHOPHYSIOLOGY

12. PATHOPHYSIOLOGY

13. PATHOPHYSIOLOGY

14. PATHOPHYSIOLOGY
• Major mediators of the symptoms (CNS) of anxiety disorders:
 Norepinephrine
 Serotonin,
 Dopamine
 Gamma-aminobutyric acid (GABA)
Other neurotransmitter : Corticotropin-releasing factor *
• The most commonly considered are the serotoninergic and
noradrenergic neurotransmitter systems.
under activation
over activation

15. PATHOPHYSIOLOGY
• Disruption of the gamma-aminobutyric acid (GABA) system has also been
implicated because of the response of many of the anxiety-spectrum disorders to
treatment with benzodiazepines
GABA = Glutamate=impact anxiety response
• There has also been some interest in the role of corticosteroid regulation and its
relation to symptoms of fear and anxiety.
• Corticosteroids might increase or decrease the activity of certain neural pathways,
affecting not only behavior under stress but also the brain's processing of fear-
inducing stimuli.
• Although a genetic predisposition to developing an anxiety disorder is
likely, environmental stressors clearly play a role in varying degrees.

16. INVESTIGATIONS
No biologic markers are specific enough at this time to detect anxiety early, and
no research shows that current medications prove efficacious in preventing these
disorders.
• It is therefore important to screen for specific risk factors:
o strong family psychiatric history
o concurrent substance abuse.

17. NATURAL HISTORY
Levels of anxiety
• Mild Anxiety
• Moderate Anxiety
• Severe Anxiety
• Panic
• Anxiety Disorder
Complications
 Depression
(which often occurs with anxiety disorder)
 Substance abuse
 Trouble sleeping (insomnia)
 Digestive or bowel problems
 Headaches
 Suicide
 Poor quality of life

18. MANAGEMENT
• Identification of stress and trigger factors
– Identify the problem. When you have identified the situations that are contributing
to your anxiety, write down the problem and be very specific in your description,
including what is happening, where, how, with whom, why, and what you would
like to change.
– Come up with as many options as possible for solving the problem, and consider the
likely chances that these will help you overcome your problem.
– Select your preferred option.
– Develop a plan for how to try out the option selected and then carry it out.
– If this option does not solve the problem remember that there are other options to
try.
– Go back to the list and select your next preferred option.
• Breathing exercises
• Thought management
• Lifestyle changes

19. MANAGEMENT
Psychological Therapies
• Cognitive behavior therapy
• Behaviour therapy

20. Treatment of Anxiety Disorders
Treatment usually consists of a combination of
pharmacotherapy and/or psychotherapy.

21. bBenzodiazepenes

22. References
1. Text book of Clinical Pharmacy and
Therapeutics
2. Text book of Pharmacology by RANG and
DALE’S.
3. Essentials of Medical Pharmacology by
Tripathi.