This document summarizes different types of anxiety disorders and their pharmacological treatments. It discusses generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobic disorders, and stress disorders. For each disorder, it provides details on symptoms and recommended drug classes for treatment, including benzodiazepines, azapirone drugs like buspirone, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. It also discusses future prospects for new anxiolytic drugs that target cholecystokinin, alpiderm, corticotropin-releasing factor, and neuroactive steroids.

1. ANTI-ANXIETY
DRUGS
VIJAY SALVEKAR
DEPT. OF PHARMACOLOGY
GRY INSTITUTE OF PHARMACY

2. Anxiety
 Unpleasant state of tension,
apprehension[fear]or uneasiness
[discomfort] that seems to arise
from an unknown source.
 Usually associated with somatic
symptoms tachycardia, sweating,
tremor, palpitation, hyper apnea,
etc

4. ANXIETY DISORDERS
o Panic Disorder- sudden periods of
intense fear that may include
palpitations, sweating, shaking,
shortness of breath, numbness, or a
feeling that something terrible is going
to happen.

6. 2.Generalized Anxiety Disorder- a disorder
characterized by excessive or unrealistic
anxiety about two or more aspects of life
(work, social relationships, financial matters,
etc.), often accompanied by symptoms such
as palpitations, shortness of breath, or
dizziness

8. Phobic Disorders- intense, persistent,
and recurrent fears of certain objects
(such as snakes, spiders, or blood) or
situations (like heights, speaking in front
of a group, and public places).

10. Stress Disorders-
mental health disorders that are a result of an
atypical response to both short and long-term
anxiety due to physical, mental, or
emotional stress. These disorders can include,
but are not limited to
obsessive-compulsive disorder and
posttraumatic stress disorder.

12. oObsessive-Compulsive Disorder-
A psychiatric disorder characterized by obsessive thoughts
and compulsive actions, such as cleaning, checking,
counting, or hoarding. (OCD), one of the anxiety disorders,
is a potentially disabling condition that can persist
throughout a person's life. The individual who suffers
from OCD trapped in a pattern of repetitive thoughts and
behaviors that are senseless and distressing but extremely
difficult to overcome. OCD occurs in a spectrum from mild
to severe, but if severe and left untreated, can destroy a
person's capacity to function at work, at school, or even in
the home.Treatment includes talk therapy, medication or
both.

17. Anti anxiety drugs
o Mostly mild CNS depressants
o Control the symptoms of anxiety,
produce a restful state of mind
without interfering with normal
mental or physical functions.

18. Classification
1. Benzodiazepines: Diazepam ,Chlordiazepoxide
Oxazepam, Lorazepam, Alprazolam, Flurazepam
2) Azapirones :Buspirone ,Gepirone, Ipsapirone
3) Sedative Antihistaminic: Hydroxyzine
4) Beta blockers :Propranolol
5) Others: selective serotonin reuptake inhibitor[SSRIs]
6) tricyclic antidepressant. [TCA]
7) MAO- inhibitors
8) Serotonin-norepinephrine reuptake inhibitos [SNRI]
(venlafaxine)
 Meprobamate , Clonidine,

19. Benzodiazepines
Site of action: mid brain ,ascending
reticular formation ,&limbic system
MOA:
By post synaptic inhibition through
BZD receptor

21. PK of Benzodiazepines
 Given orally ,iv & im (lorazepam & temazepam)
 Oral absorption good
 Phase I & phase II metabolism
 Lorazepam & Oxazepam  no active metabolite 
short acting

22. ADR
 Sedation
 Light headedness
 Cognitive impairment
 Vertigo
 Confusion
 Appetite & Wt gain
 Alter in sexual function
 Dependence

23. Advantages of BZD
 High therapeutic index
 Do not affect respiration or cardiovascular
function
 No microsomal induction
 Specific BZD antagonist Flumazenilis
available

24. CHLORDIAZEPOXIDE
 First BZD used as an antianxiety
agent
 Produce smooth long lasting effect
 Preferred in chronic anxiety states
 T1/2 :5-15 hours
 Dose : 20-100 mg

25. OXAZEPAM
 Hepatic metabolism is less significant
 It is preferred in the elderly and those with
liver disease
 Short duration of action
 Used in short lasting anxiety state

26. LORAZEPAM
 Oral & IM administration
 No active mtb
 Short acting  preferred in elderly
 Used in short lasting anxiety ,Panic, OCD,
tension syndrome
 Dose: 1 - 6mg/day

27. ALPRAZOLAM
Anxiolytic + antidepressant
High potency anxiolytic
Useful in anxiety associated with
depression
Less drowsiness
Dose : 0.25-0.5mg BD or TDS

28. AZAPIRONES
 Buspirone , Gepirone, Ipsapirone
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

29. 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

30. PK
 given orally, rapidly absorbed
 Extensive first pass metabolism
 Excreted through urine and faeces
ADR
 Dizziness ,headache, Nausea
 Tachycardia , Pupillary Constriction
DOSE: 5-10mg OD-TDS

31. SSRI in Anxiety
 Preferred in chronic anxiety states
 Started in low dose
 Slow onset of action
 Started along with BZD

32. Beta blockers
o Propranolol :reduce the symptoms of
anxiety
o They do not affect the psychological
symptoms (worry ,tension, anxiety)
o Used for performance/situational anxiety
o Dose: 20-40mg 2hr before the
performance

33. Different type of anxiety and its and
its management
 Generalized Anxiety Disorder: persistent excessive,
unrealistic worry associated with somatic symptoms.
 Acute phase – Benzodiazepines are preferred
 Rapid onset of action
 Eg: lorazepam, Oxazepam
 Not ideal for long term treatment due to abuse
liability & development of tolerance
 For long term use : Buspirone ,SSRIs .

34. Obsessive-Compulsive Disorder
 Obsessive thoughts and compulsive behaviors that impair
everyday functioning
 Treatment
o TCA (clomipramine) poorly tolerated
o SSRI
• Fluoxetine (5–60 mg/d),
• fluvoxamine (25–300 mg/d),
• sertraline (50–150 mg/d)
o Buspirone
o BZD

35. Panic Disorder:
Recurrent and unpredictable panic
attacks, with intense discomfort and fear
of impending doom or death.
Treatment
• SSRIs low doses
• Eg: 5–10 mg fluoxetine, 25–50 mg sertraline,
10 mg paroxetine

36. Phobic Disorders
 Persistent fear of objects or situations, exposure to
which results in an immediate anxiety reaction. The
patient avoids the phobic stimulus, and this
avoidance usually impairs occupational or social
functioning.
 Treatment
o Beta blockers : Propranolol 20–40 mg orally 2 h before
the event (performance anxiety)
o SSRIs
o MAO inhibitors

37. Stress Disorders
 Anxiety following exposure to extremetraumatic events.
The reaction may occur shortly after the trauma (acute
stress disorder) or be delayed and subject to recurrence
(PTSD) . In both syndromes, individuals experience
associated symptoms of detachment and loss of
emotional responsivity.
 Treatment
o Benzodiazepines and supportive/expressive
psychotherapy
o SSRI
o MAO inhibitors

38. Future prospects
 Cholecystokinin (CCK) antagonists
 Alpiderm: partial agonist on BZD
receptor
 Corticotropin-releasing factor (CRF)
antagonists
 Neuroactivesteroids

39. THANK YOU