Anti-Anxiety and Anti-Depressant drugs used in the clinical practice.

• Relaxation techniques (used in mild/moderate anxiety),
• Anxiety management,
• Bio-feedback,
• Behaviour therapies,
• Cognitive behaviour therapies.

Drug treatments in occurrence of anxiety disorders.

        Drugs used in treatments of anxiety are divided up into two groups,

1. Those that act primarily on the Central Nervous System (CNS)
2. Those that block Peripheral autonomic receptors.

Anxiolytics:

Benzodiazepines are centrally acting anxiolytic drugs, they are used in the alleviation of anxiety states and are readily prescribed for almost anyone suffering from stress related symptoms. Benzodiazepines are NOT appropriate for treating depression or chronic Psychosis. Benzodiazepines should be limited to the lowest possible dose for the shortest possible time period as dependence is likely especially in patients with a previous history of alcohol or drug abuse.

Benzodiazepines include:

• Diazepam (used in short term anxiety or insomnia)
• Alprazolam (used for short periods in patients with anxiety)
• Chlordiazepoxide (used in anxiety (short term) and alcohol withdrawal)
• Lorazepam (used short term in anxiety, epilepsy and insomnia, also peri-operatively {during/around surgery})
• Oxazepam (used short term in anxiety)

Buspirane Hydrochloride, also part of the Anxiolytics group is thought to act on specific Serotonin receptors; response to treatment takes up to two weeks and should not be used in conjunction with any Benzodiazepines.

Beta-Blockers (β-Blockers):

        β-Blockers do not affect psychological symptoms such as, worry, tension and fear but however, may reduce physical/autonomic symptoms such as palpitations and tremor. β-Blockers are therefore indicated for patients with predominantly somatic symptoms which in turn may prevent the onset of worry and fear. β-Blockers are usually used in cased or Hypertension (high Blood Pressure).

β-Blockers include:

Side effects of β-Blockers include:

Barbiturates:

        Barbiturates are used to treat severe intractable insomnia in patients already taking barbiturates and should be avoided in the elderly. Side effects of barbiturates include: Hang over with drowsiness, dizziness, Ataxia, respiratory depression, hypersensitivity reactions, headache, and excitement/confusion.

Anti-depressant drugs:

        Anti-depressants are effective in the treatment of depression of moderate to severe degree, they are broken up into 4 categories:

1. Tricyclic + related anti-depressant drugs,
2. Monoamine Oxidase Inhibitors (MAOI’s),
3. Selective Serotonin Reuptake Inhibitors (SSRI’s)
4. Other anti-depressant drugs.

Tricyclic + related anti-depressant drugs:

        These drugs are most effective for treating moderate – severe endogenous depression (disease derives from internal causes) associated with psychomotor and physiological changes, such as loss of appetite (anorexia) and sleep disturbances (improvement in sleeping pattern is usually the first benefit of the treatment), an interval of 2 weeks may present before the onset of the anti-depressant action and in cases of severe depression Electro Convulsive Therapy (ECT) may be required.

Tricyclic antidepressants include:

Amitriptyline hydrochloride,

Amoxapine,

Clomipramine hydrochloride,

Dosuleoin/Dothiepin hydrochloride,

Doxepin,

Imipramine hydrochloride,

Lofepramine,

Nortriptyline,

Trimipramine.

Maprotiline hydrochloride

Mianserin hydrochloride

Trazodone hydrochloride

Monoamine Oxidase Inhibitors (MAOI’s):

        MAOI’s are used much less frequently then Tricyclic or SSRI’s because of dangers of dietary and drug interactions, patients with phobias and hypochondriacal or hysteria features are said to respond best to MAOI’s, response to treatment may be delayed for up to 3 weeks or more and may take an additional 1-2 weeks to perform at their maximum level. Withdrawal from MAOI’s should be done gradually if at all possible and other anti-depressants should not be started for a further 2 weeks after treatment with MAOI’s.

MAOI’s include:

Phenelzine,

Tranylcypromine,

Isocarboxazid,

Moclobemide.

Selective Serotonin Reuptake Inhibitors (SSRI’s):

SSRI’s inhibit the re-uptake of serotonin, they should be used with caution in patients with epilepsy and ECT treatment. SSRI’s are less sedating and have fewer antimuscarinic and cardiotoxic effects than Tricyclic antidepressants.

SSRI’s include:

Citalopram (Cipramil),

Fluoxetine (Prozac),

Fluvoamine Maleate,

Paroxetine (Seroxat),

Sertraline (Lustral).

Side effects to Antidepressant drugs are vast and contain:

Dry mouth,

Sedation,

Blurred vision,

Constipation,

Nausea,

Difficulty in micturation,

Cardio-vascular side effects,

Sweating,

Tremor,

Rashes,

Hypersensitivity reactions,

Urticaria (nettle rash),

Photosensitivity,

Behavioural disturbances,

Mania,

Confusion,

Interference with sexual function,

Blood sugar changes,

Increased appetite and weight gain,

Testicular enlargement,

Gynaecomastia (male development of breast tissue),

Convulsions (seizures),

Blood disorders,

Abnormal liver function.

References:

British National Formulary (BNF) March 2002, 43rd Ed.

Clark, M., Kumar, P., 2002, Clinical medicine, 5th Ed. W.B. Saunders, London.

*IMPORTANT NOTICE*:

        Information in this booklet is only a brief overview of treatments and drugs used in anxiety and depression. Side effects are not always experienced and people currently taking any such medications should never consider altering dosage or stopping treatment without seeking expert medical advice, doing so could cause complications, side effects and withdrawal symptoms in itself. Self-diagnosis should not be made from the brief information in this booklet and any concerns should be discussed with a medical practitioner.