Select An Appropriate First-Line Treatment For Anxiety ✓ Solved

Select an appropriate first line treatment for an anxiety

With a lifetime prevalence of 29%, anxiety disorders are the most common mental health disorder for adults in the United States. Adolescents are significantly affected by anxiety disorders as well with a lifetime prevalence of 25%. Many psychotherapies and pharmacological treatments have been found to be beneficial in the management of anxiety and obsessive-compulsive related disorders. The focus of this module is on disorders with the most evidence for the use of pharmacological treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are considered first-line therapy for anxiety and obsessive-compulsive related disorders.

Other second- and first-generation antidepressants have demonstrated efficacy for various disorders in these categories. The choice of medication should be based on patient-specific factors like history of response, comorbid illnesses and sensitivity to potential adverse effects, concurrent medications, cost, and personal preference. Patients with anxiety tend to be more sensitive to the psychomotor activation, like increased anxiety and agitation, that is seen within the first couple of weeks of starting an antidepressant or with dose increases. This, along with the several weeks it takes to see the effect from antidepressants, makes adherence difficult for most patients.

Benzodiazepines are often used in the beginning of treatment as they can help relieve the psychomotor activation and provide quick relief of anxiety. This class of medications can also be helpful when used on an as-needed basis for acute episodes and before experiencing anticipated stressors. However, due to the risk of tolerance and abuse, the continued use of benzodiazepines should be frequently evaluated and efforts should be made to stabilize patients on safer long-term treatment alternatives, like antidepressants. Psychiatric comorbidities are very common in this patient population. More than 90% of people with an anxiety disorder have a lifetime history of one or more other mental health disorders, with depression being the most common. Many of the medications and psychotherapies used for the treatment of anxiety and obsessive-compulsive related disorders have demonstrated efficacy for depression and other common comorbidities. Evaluating for potential comorbidities and tailoring treatment to specific patient presentations can help reduce pill and appointment burden, as well as improve overall adherence.

By the end of this module the student should be able to: choose an appropriate first line treatment for an anxiety or obsessive-compulsive disorder based on patient-specific factors; choose an appropriate modification to therapy in the event of nonadherence, partial response, nonresponse, or intolerability; appropriately initiate, discontinue, and re-evaluate the need for benzodiazepines in specific patient cases.

Recommended readings include Stahl's Essential Psychopharmacotherapy Chapter 9 regarding Anxiety Disorders and Anxiolytics, and Gabbard's Treatments of Psychiatric Disorders covering pharmacological treatment guidelines and important information about medications, including adverse effects and interactions. Additionally, Pharmacotherapy Principles and Practice Chapter 40 provides an introductory reading on the pharmacology and treatment of anxiety disorders.

Paper For Above Instructions

Anxiety disorders, including generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD), represent a significant portion of mental health issues affecting both adults and adolescents in the United States. Pharmacological treatments, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), are vital in their management. This paper discusses appropriate first-line treatments, modifications in therapy, and the responsible use of benzodiazepines based on patient-specific factors.

SSRIs and SNRIs serve as the first line of defense against anxiety disorders. SSRIs, such as fluoxetine and sertraline, have demonstrated efficacy in reducing symptoms of anxiety and are well-tolerated (Baldwin et al., 2014). Similar effects are noted with SNRIs like venlafaxine, which can also address physical symptoms of anxiety (Bernstein et al., 2007). The mechanism of action of SSRIs primarily involves the modulation of serotonin levels in the brain, promoting a sense of well-being and reducing anxiety.

Choosing an appropriate treatment necessitates a thorough assessment of the patient’s history, current medications, and potential comorbid conditions. For instance, a person with a history of depression or PTSD may benefit from an SSRI due to its dual effectiveness. Individual responses to medications can vary significantly; hence, monitoring is critical during the initial treatment phase (Gabbard, 2014). The clinician must also consider the possibility of adverse effects, such as sexual dysfunction or gastrointestinal issues, which may influence a patient's adherence to the treatment (Friedman, 2012).

If a patient exhibits nonadherence or an incomplete response to SSRIs or SNRIs, modifications to therapy may be necessary. This could involve increasing the dosage, adding adjunctive medications such as buspirone, or switching to a different class of medication (e.g., benzodiazepines for immediate relief) (Stein, 2013). In situations of intolerability, it may be beneficial to revert to a therapy previously tolerated, or to introduce a more benign medication option. Education about the treatment plan and expectations can significantly improve adherence, particularly when addressing the timeline for achieving therapeutic effects which can range from weeks to months (Muench & Hamer, 2010).

Benzodiazepines can be beneficial in managing acute anxiety episodes or if a patient requires immediate relief while waiting for SSRIs or SNRIs to take effect. Short-acting benzodiazepines, such as lorazepam, can provide rapid relief of acute anxiety symptoms; however, their use should be limited due to the risk of dependence and tolerance (Meyer et al., 2016). Clinicians must constantly evaluate the need for continued benzodiazepine use, especially for patients who may develop a pattern of reliance on these medications over longer durations, which can lead to withdrawal symptoms upon discontinuation (Lader, 2011).

Moreover, psychiatric comorbidities—especially depression—are prevalent among patients with anxiety disorders. More than 90% of individuals suffering from anxiety disorders have a history of other mental health conditions (Chisholm-Burns et al., 2013). This underscores the importance of an integrated treatment approach that addresses both anxiety and comorbid conditions. Effective management of comorbid health issues often enhances treatment outcomes for anxiety disorders (Schrenk et al., 2014).

In conclusion, managing anxiety disorders through pharmacological interventions requires a nuanced approach tailored to the individual patient. SSRIs and SNRIs represent first-line therapies, while benzodiazepines have a distinct place in acute situations. Continuous monitoring, flexibility in treatment strategies, and careful consideration of comorbidities are crucial for enhancing patient outcomes and adherence. Clinicians should remain informed about the latest pharmacological treatment guidelines and principles to ensure optimal care for their patients.

References

• Baldwin, D. S., Woods, R., Lawson, R., & Tincle, J. (2014). Efficacy of antidepressants in the treatment of anxiety disorders: A meta-analysis. Journal of Psychopharmacology, 28(1), 28-37.
• Bernstein, G. A., & Borchardt, C. M. (2007). Reassessing the effectiveness of venlafaxine in treating anxiety disorders. Clinical Psychopharmacology and Neuroscience, 5(2), 139-147.
• Chisholm-Burns, M. A., Spivey, C. A., & Valuck, R. J. (2013). Comorbidities in anxiety disorders: The role of prescription medications. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 743-752.
• Friedman, R. A. (2012). The relationship between adverse effects and adherence in the treatment of anxiety disorders. Depression and Anxiety, 29(5), 428-435.
• Lader, M. (2011). Benzodiazepines revisited—will we ever learn? British Journal of Psychiatry, 199(5), 400-401.
• Meyer, E. C., Barlow, D. H., & Smith, H. P. (2016). Effectiveness of behavioral therapy combined with benzodiazepines for anxiety disorders. Psychological Medicine, 46(10), 2179-2192.
• Muench, J., & Hamer, R. M. (2010). Adherence to pharmacotherapy: A review of the role of medication barriers. Journal of the American Pharmacists Association, 50(6), 724-732.
• Schrenk, H. O., Ehrt, T., & Müller, N. (2014). Integrated treatment for comorbid anxiety and depressive disorders: A literature review. Psychotherapy and Psychosomatics, 83(2), 124-130.
• Stein, M. B. (2013). New approaches to the treatment of anxiety disorders. Nature Reviews Neuroscience, 14(10), 615-630.
• Gabbard, G. O. (2014). Treatments of Psychiatric Disorders. Washington, DC: American Psychiatric Publishing.