Dr.
Shazia Habib
Presented by: (Group 1)
Khadija Khan (230615)
Laiba Hanif (230629)
Faizan Nawaz (230634)
Department of Applied Psychology
Govt. College University Faisalabad
Anxiety Disorders
Anxiety disorders involve excessive worry, fear, or
nervousness.
They can significantly impact daily life and
functioning.
Examples include Generalized Anxiety Disorder
(GAD), Panic Disorder, Social Anxiety Disorder
(SAD), and specific phobias
Obsessive
Compulsive Disorder
➢ OCD is characterized by:
Obsessions: Recurrent, unwanted thoughts,
images, or urges.
Compulsions: Repetitive behaviors or mental
acts performed to reduce anxiety or prevent
perceived harm.
➢ OCD can lead to significant distress and
impairment in various areas of life.
Treatment
Psychopharmacological
Usually a type of antidepressant medicine that can help
by altering the balance of chemicals in your brain
Psychotherapeutic
Cognitive-behavioral therapy (CBT), Exposure therapy,
Mindfulness-based therapy
Importance of Psychopharmacology
• Pharmacotherapy refers to the use of medications
in treatment.
• It plays a crucial role in managing symptoms of
anxiety disorders and OCD.
• Provides relief, especially for moderate to severe
cases.
Types of Medicines Used
Benzodiazpines SSRIs
SNRIs TCAs
Mechanism of Action
Medications target Alleviate anxiety
neurotransmitters in symptoms
the brain
Reduce the frequency
and intensity of
Regulate mood
obsessive thoughts and
compulsive behaviors
Combined Approach
• Pharmacotherapy should be used in
conjunction with:
• Therapy (e.g., cognitive-behavioral
therapy)
• Lifestyle changes
• Other non-pharmacological
interventions
• Combined approach yields the most
effective treatment outcomes.
▪ Anxiolytics are medications
that can
treat anxiety symptoms.
▪ “Anxiolytic” combines two root
words from ancient Greek,
“anxio-” meaning “anxiety” and
Anxiolytics
“-lytic,” meaning “to loosen.”
▪ These medications “loosen”
anxiety’s hold on us.
Benzodiazepines
➢ Widely used class of anxiolytic medications.
➢ Effective for short-term management of anxiety
symptoms.
Mechanism of Action
➢ Enhance the activity of gamma-aminobutyric acid
(GABA), a neurotransmitter that inhibits brain
activity.
➢ Result in calming and sedative effects.
➢ Modulate the brain's response to anxiety.
Common Benzodiazepines
➢ Xanax (alprazolam)
➢ Valium (diazepam)
➢ Ativan (lorazepam)
➢ Klonopin (clonazepam)
➢ Others: Librium, Tranxene, Restoril
Xanax (alprazolam)
Effect: It produces calming effects by enhancing the activity
of GABA receptors in the brain, leading to decreased anxiety
and relaxation.
Dosage: Typical 0.25-0.5 mg taken orally three times daily.
The dosage may be gradually increased as needed, with the
maximum daily dose typically not exceeding 4 mg. For panic
disorder, initial doses may be higher, around 0.5-1 mg taken
orally two to three times daily
Side Effects
Valium (diazepam)
Effect: Used for various conditions, including anxiety disorders,
muscle spasms, and alcohol withdrawal. It results in anxiolytic,
muscle relaxant, and sedative effects.
Dosage: For anxiety, the usual starting dose is 2-10 mg taken
orally two to four times daily. Not exceeding 30 mg per day. For
muscle spasms, lower doses may be used initially.
Side Effects of Valium
▪ Drowsiness
▪ Fatigue
▪ Muscle weakness
▪ Unsteady gait
▪ Cognitive issues
Ativan (lorazepam)
Effect:
For the short-term relief of anxiety symptoms and panic attacks.
Approved for treating seizures, chemotherapy-related nausea and
vomiting, anxiety, pre-anesthesia for surgery and procedures, and
phobias.
Dosage:
1-2 mg taken orally two to three times daily. Maximum daily
dose typically not exceeding 10 mg. For panic disorder, initial
doses may be higher, around 2-3 mg taken orally two to three
times daily.
Klonopin (clonazepam)
Effect:
Klonopin is used for the treatment of panic disorder, certain
types of seizures, agitation and sometimes for social anxiety
disorder.
Dosage:
For adults with panic disorder is 0.25 mg taken orally twice
daily. The dose may be gradually increased every 3 days until
panic disorder is controlled, with the maximum recommended
dose being 4 mg per day. For seizures, the starting dose is
usually higher, and adjustments are made based on response.
Benefits of Benzodiazepines
➢ Rapid onset of action.
➢ Effective for acute anxiety episodes or panic
attacks.
➢ Generally well-tolerated when used short-term and
at low doses.
➢ Can be helpful for specific phobias and social
anxiety disorder.
Limitations of Benzodiazepines
➢ Risk of tolerance and dependence with long-term use.
➢ Potential for withdrawal symptoms upon discontinuation.
➢ Sedation, dizziness, and impaired coordination are common side effects.
➢ Not recommended for long-term use or as first-line treatment for chronic
anxiety disorders.
Risk of Abuse and Addiction
➢ Benzodiazepines can be habit-forming.
➢ Misuse and abuse may lead to addiction.
➢ Caution should be exercised, especially in individuals with a history of
substance abuse.
Buspirone
It is sold under the brand name Buspar, among others,
is an anxiolytic, a medication primarily used to
treat anxiety disorders, particularly generalized anxiety
disorder. It is a serotonin 5-HT1A receptor agonist,
increasing action at serotonin receptors in the brain. It
is taken orally, and takes two to six weeks to be fully
effective
Mechanism of Action
➢ Buspirone is an anxiolytic medication.
➢ It acts as a serotonin 5-HT1A receptor partial agonist.
➢ Buspirone's anxiolytic action is believed to result from its
modulation of serotonin activity in the brain.
Efficacy
➢ Primarily for the treatment of generalized anxiety disorder (GAD)
➢ It may take several weeks of regular use to achieve full therapeutic
effects.
➢ Studies have shown that buspirone is effective in reducing anxiety
symptoms in patients with GAD.
Side Effects
Common side effects of buspirone may include:
➢ Dizziness
➢ Nausea
➢ Headache
➢ Nervousness
➢ Lightheadedness
Comparison with Benzodiazepines
➢ Unlike benzodiazepines, buspirone does not cause
sedation or impair cognitive function.
➢ It does not carry the risk of tolerance, dependence, or
withdrawal symptoms associated with benzodiazepines.
➢ Buspirone may be preferred for individuals who have a
history of substance abuse or concerns about the
potential for addiction.
➢ However, it may not provide immediate relief for acute
anxiety symptoms and is generally less potent than
benzodiazepines.
Hydroxyzine
Sold under the brand names Atarax and Vistaril among others, is
an antihistamine medication. It is used either by mouth or injection
into a muscle.
Mechanism of Action
➢ Hydroxyzine acts as an antagonist at histamine H1 receptors in
the brain.
➢ It also exhibits anxiolytic effects through its sedating properties
and modulation of serotonin and noradrenaline activity.
Use as an Adjunct or Alternative
Hydroxyzine is an antihistamine with anxiolytic properties.
It is commonly used as an adjunct or alternative treatment
for anxiety disorders, particularly when other medications
are ineffective or not well-tolerated.
Hydroxyzine may be prescribed off-label for anxiety,
insomnia, and pruritus (itching).
Side Effects
➢ Common side effects of hydroxyzine may include:
Sedation
Dizziness
Dry mouth
Blurred vision
Constipation
Urinary retention
➢ Less common side effects may include confusion, tremors,
and hypotension.
➢ Hydroxyzine may cause significant sedation, especially at
higher doses, which can impair cognitive function and
motor skills.
Hydroxyzine Warnings
➢ Pregnant women
➢ Nursing mothers
➢ Drivers and Heavy machine operators
➢ Older adult
➢ Blurry vision (glaucoma)
➢ Lung disease (asthma or COPD)
➢ Heart diseases
➢ Alcoholics and narcotics
Antidepressants
for Anxiety and
OCD
Laiba Hanif (624)
Group 1
Table of contents
01 02 03
SSRIs Frist-line treatment Mechanism of action
and therapeutic effects
04 05 06
SNRIs TCAs & MAOIs Side effect profiles
01.
Introduction
Introduction
Antidepressants are pivotal in managing anxiety
disorders and obsessive-compulsive disorder (OCD),
conditions that significantly impact millions globally.
In this presentation, we'll explore how medications
like SSRIs, SNRIs, TCAs, and MAOIs work to alleviate
symptoms, providing crucial relief and improving the
quality of life for those affected.
SSRIs
Usage
First-line treatment for various anxiety disorders (e.g., generalized anxiety
disorder, social anxiety disorder) and OCD.
Example
- Prozac (fluoxetine): Introduced in 1987, widely prescribed for anxiety and
depression.
- Zoloft (sertraline): Approved for OCD treatment in 1999, also used for
panic disorder.
- Lexapro (escitalopram): Known for high tolerability, often used in anxiety
disorders.
SSRIs
Mechanism of Therapeutic
Action effect
Inhibit the reuptake of Reduce anxiety symptoms,
serotonin, enhancing its obsessive thoughts, and
availability in the synaptic compulsive behaviors.
cleft.
Statistics
SSRIs are prescribed to
millions of individuals
globally, with Prozac being
one of the most commonly
prescribed antidepressants.
SNRIs
Usage
Employed in treatment-resistant anxiety cases or when depression coexists
with anxiety disorders.
Example
- Effexor (venlafaxine): Dual-action SNRI used for various anxiety disorders
and depression.
- Cymbalta (duloxetine): Indicated for generalized anxiety disorder and
chronic pain management.
SNRIs
Mechanism of Therapeutic
Action effect
Inhibit the reuptake of both Improve mood, reduce
serotonin and norepinephrine, anxiety symptoms, and
modulating mood and anxiety alleviate certain types of
response. chronic pain.
Statistics
SNRIs are increasingly
prescribed due to their
efficacy in managing both
anxiety and depressive
symptoms.
TCAs & MAOIs
Usage
Reserved for refractory cases where SSRIs and SNRIs are ineffective or not
tolerated.
Example
- TCAs like amitriptyline and nortriptyline are used for severe anxiety and
OCD.
- MAOIs such as phenelzine and tranylcypromine are considered when other
options fail.
TCAs & MAOIs
Mechanism of Therapeutic
Action effect
TCAs block serotonin and Effective in treating severe
norepinephrine reuptake, symptoms but have a
while MAOIs inhibit higher risk of side effects
monoamine oxidase enzyme and interactions.
activity.
Statistics
TCAs and MAOIs usage has
declined due to the
development of safer and
more tolerable alternatives
like SSRIs and SNRIs.
Side Effects
SSRIs SNRIs TCAs & MAOIs
• Gastrointestinal • Nausea, vomiting, or • Dry mouth, blurred
disturbances digestive issues vision, or constipation
• Headache, dizziness, or • Drowsiness or fatigue • Drowsiness or sedation
lightheadedness
• Dry mouth or changes • Weight gain
• Changes in sleep patterns in taste perception
• Urinary retention
• Sexual dysfunction • Increased sweating
• Tremors or muscle
• Weight changes • Sexual dysfunction stiffness
Other
Medications
● Anxiety disorders and Obsessive-Compulsive
Disorder (OCD) are prevalent mental health
conditions affecting millions worldwide. While
selective serotonin reuptake inhibitors (SSRIs)
and serotonin-norepinephrine reuptake inhibitors
(SNRIs) are commonly prescribed, several other
medications show promise in managing
symptoms.
● We will discuss two such medications that are
used to treat such patients: beta-blockers and
pregabalin/gabapentin.
Beta-blockers (e.g., propranolol)
● Function: Primarily used to treat hypertension and cardiac conditions, beta-
blockers like propranolol can also alleviate symptoms of performance anxiety and
specific phobias.
● Mechanism of Action: Blocks the effects of adrenaline, reducing the physical
symptoms of anxiety such as rapid heartbeat, trembling, and sweating.
Continue..
Clinical Applications
● Performance Anxiety: Beta-blockers are frequently employed by individuals facing
situations characterized by heightened performance anxiety, such as public
speaking engagements, musical performances, or athletic competitions.
● Specific Phobias: In scenarios where exposure to specific triggers induces
overwhelming anxiety responses (e.g., fear of flying, heights, or enclosed spaces),
beta-blockers can help manage physiological symptoms, enabling individuals to
navigate such situations with greater ease.
Continue…
● Effectiveness: Studies indicate beta-blockers'
efficacy in curbing physical manifestations of
anxiety, though they do not address psychological
aspects.
● Efficacy and Considerations: Research suggests
beta-blockers' efficacy in attenuating physical
symptoms of anxiety. However, it's crucial to note
that they do not address the underlying
psychological components of anxiety disorders.
Additionally, individual responses to beta-blockers
may vary, and cautious dosing is essential,
particularly in individuals with pre-existing cardiac
conditions or asthma.
Pregabalin and Gabapentin:
● Function: Originally developed to treat epilepsy, pregabalin and gabapentin are
now prescribed as adjunctive treatments for certain anxiety disorders.
● Mechanism of Action: Both medications modulate the release of
neurotransmitters, particularly gamma-aminobutyric acid (GABA), which helps calm
overactive nerve firings associated with anxiety.
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