Anxiety disorders combination therapy

Tablet combination therapy Adverse reactions occurring in at least 3% of patients include the following Abdominal pain alopecia anemia anorexia anxiety arthralgia back pain bacterial infection blurred vision concentration impairment cough depression dermatitis diarrhea dizziness dry mouth/skin dyspepsia dyspnea eczema fatigue/asthenia headache hypothyroidism increased sweating injection site reaction insomnia irhtability/anxiety/nervousness lymphopenia memory impairment mood alteration myalgia nausea neutropenia pain pruritus pyrexia rash resistance mechanism disorders rigors thrombocytopenia vomiting weight decrease.

Bond Al, Wingrove 1, Valerie CH, Lader MH. Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. 1 Affect Disord 2002 72 267-271. 

This conclusion stands in contrast to the statements made in an earlier review (Kauffmann and Hallahan, 1979) that behavioral therapeutic techniques have an important role to play in ADHD, and partly contradicts the results of some more recent studies. As summarized in Chapter 7 (p. 250 f.), the US MTA study did not detect any significant difference between combined treatments and treatment with methylphenidate alone with regard to their effects on ADHD symptoms however combined treatments had some advantage over drug alone on features such as anxiety disorders, social skills, consumer (mainly parent) satisfaction and possibly academic achievement (Pelham et al., 2000). Additional statistical analysis of the MTA study by responders and in terms of composite outcome measures also revealed additional benefit of combined treatments over drug therapy alone (Jensen et al., 2001). 

Most of the medications used in the treatment of anxiety disorders are those used in treating depressive disorders, and many of the comments made in the previous chapter are applicable here, including the rational selection of mediation, initiation, and duration of treatment, as well as the identification and management of side effects. An important observation to remember is that patients with anxiety disorders have a tendency to relapse relatively quickly once medications are discontinued, whereas the impact of behavioral therapies appears to be longer lasting. Once again, a close collaborative effort between the therapist and the physician can guide the selection of the most appropriate form of treatment and/or combination of treatments, as well as their duration. 

Anxiety disorders are common in the population and are commonly comorbid with other psychiatric disorders. The proper management of anxiety disorders begins with the correct diagnosis not all patients should receive antianxiety agents. Nonpharmacologic interventions often are effective alone or when combined with drug therapy. 

In 488 children and adolescents (aged 7-17 years) with an anxiety disorder who were randomized to 12 weeks of sertraline up to 200 mg/day, cognitive behavioral therapy, the combination of these, or placebo, suicidal and homicidal ideation were no more common with sertraline than placebo no child attempted suicide [9 ]. 

The most commonly used therapies for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs) and the more recently developed serotonin noradrenaline reuptake inhibitors (SNRIs). SSRIs, which constitute 60% of the worldwide antidepressant and antianxiety market, are frequently associated with sexual dysfunction, appetite disturbances and sleep disorders. Because SSRIs and SNRIs increase 5-HT levels in the brain, they can indirectly stimulate all 14 serotonergic receptor subtypes [2,3], some of which are believed to lead to adverse side effects associated with these drugs. Common drugs for short-term relief of GAD are benzodiazepines. These sedating agents are controlled substances with addictive properties and can be lethal when used in combination with alcohol. The use of benzodiazepines is associated with addiction, dependency and cognitive impairment. 

Patients with bipolar disorder frequently require multiple medications or changes in therapy. For example, antianxiety agents are helpful in reducing anxiety and agitation, especially in patients who refuse antimanic or antipsychotic agents. Likewise an added antipsychotic is more effective than lithium alone in acute manic episodes that include significant psychomotor activity and delusions or hallucinations. Ongoing treatment with antipsychotics after the manic episode is resolved is often not necessary. However, it is not uncommon for a refractory patient to require a combination of mood stabilizers, an antidepressant, and an antipsychotic. 

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