Antidepressant drugs anxiety symptoms

Assess patients for improvement of anxiety symptoms and for return to baseline occupational, social, and interpersonal functioning. With effective treatment, the patient should have no or minimal symptoms of anxiety or depression. While drug therapy is being initiated, evaluate patients more frequently to ensure tolerability and response. Increase the dose in patients exhibiting a partial response after 2 to 4 weeks on an antidepressant or 2 weeks on a benzodiazepine. Individualize the duration of treatment because some patients require up to one year of treatment.27... 

Nefazodone is an SSRl with 5-HT2 antagonist properties. Nefazodone is licensed as an antidepressant in many countries, and the evidence for efficacy from placebo-controlled and reference-controlled studies does not suggest that this drug is associated with superior efficacy (Dillier 1982 R. Fontaine et al. 1994 Mendels et al. 1995 Rickels et al. 1994). The 5-HT2 antagonism does not appear to confer extra efficacy, which appears to be similar to that of SSRls. However, a beneficial effect on sleep and on anxiety symptoms of depression is reported. This may be attributable to 5-HT2 blockade, but some studies have demonstrated nefazodone s superior efficacy to SSRls. One attribute of nefazodone that may be related to 5-HT2 blockade is that it is associated with rather little in the way of sexual side effects. A direct comparison between nefazodone and sertraline reported significantly fewer sexual side effects with nefazodone [Baldwin 1996). 

Beta-adrenoceptor antagonists, particularly propranolol, have been shown to be effective for anxiety symptoms particularly in situational anxiety and GAD. Buspirone, an azaspirodecanedione, is an agonist at 5-HTlA receptors and seems to have anxiolytic effects, though it is less potent than the BDZs and the effects take up to three weeks to become evident. There is high first pass metabolism and a considerable proportion of the effect is due to a metabolite (1-PP). The principal adverse effects of buspirone are nausea, gastrointestinal upset and headache. Antidepressant drugs, both the older tricyclic antidepressants and the newer drugs, have been demonstrated to have anxiolytic effects in mixed anxiety-depressive patients, GAD and panic disorder. 

Many patients with anxiety also have symptoms of depression.47 It therefore seems reasonable to include antidepressant drugs as part of the pharmacological regimen in these patients. Hence, patients with a combination of anxiety and depression often take a traditional antianxiety agent such as a benzodiazepine along with an antidepressant.44 The pharmacology of the antidepressants is addressed in Chapter 7. 

The benzodiazepines are the most effective, safe, and commonly prescribed drugs for the rapid relief of acute anxiety symptoms. They are also used intermittently or adjunctively for acute GAD exacerbations and for sleep disturbances at the outset of antidepressant therapy. ... 

Antidepressants are commonly used to treat both acute withdrawal and persistent anxiety or insomnia. There is evidence to suggest that they are effective in relieving some acute abstinence symptoms, but it has been more difficult to establish their effectiveness in long-term discontinuation. Antidepressants with sedative and antianxiety effects are the preferred drugs. 

Evaluate patients for symptom improvement frequently (e.g., weekly) during the first 4 weeks of therapy. The goal is to alleviate panic attacks and reduce anticipatory anxiety and phobic avoidance with resumption of normal activities. Alter the therapy of patients who do not achieve a significant reduction in panic symptoms after 6 to 8 weeks of an adequate dose of antidepressant or 3 weeks of a benzodiazepine. Regularly evaluate patients for adverse effects, and educate them about appropriate expectations of drug therapy. 

The reason for this warning is that abrupt cessation of SSRIs produces withdrawal symptoms in about 20 per cent of patients. Symptoms of withdrawal from antidepressant medication include gastrointestinal disturbances (abdominal cramping and pain, diarrhoea, nausea and vomiting), flu-like symptoms, headaches, sleep disturbances, dizziness, blurred vision, numbness, electric-shock sensations, twitches and tremors. Abrupt withdrawal can also produce symptoms of depression and anxiety, which can occur within hours of the first missed dose of the drug.11 Withdrawal symptoms are sometimes mistaken for a relapse, leading patients to resume antidepressant medication and to conclude that they need it in order to remain free of depression. Technically, this is not considered addiction , but it does seem awfully close. 

The BZs are the most frequently prescribed drugs for the treatment of acute anxiety (Table 68-9). All BZs are equally effective anxiolytics, and most of the improvement occurs in the first 2 weeks of therapy. They are considered to be more effective for somatic and autonomic symptoms of GAD, while antidepressants are considered more effective for the psychic symptoms (e.g., apprehension and worry). 

Once a methamphetamine addict stops taking the drug, the withdrawal symptoms can be very severe and include depression and anxiety, increased appetite, fatigue, paranoia, irritability, aggressive behavior, and intense craving for the drug. Some of these symptoms can be eased with sedative drugs like Valium or antidepressants like Prozac . 

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