Anxiety disorders are common (Rosenthal & Burchum, 2021) and can manifest very differently in individuals as everyone is unique in their experiences

GAD and SSRIs

Anxiety disorders are common (Rosenthal & Burchum, 2021) and can manifest very differently in individuals as everyone is unique in their experiences, ability to cope, and resiliency. Anxiety is a healthy normal response that initiates specific responses to assist individuals in acting. Anxiety can heighten the senses, which is helpful when walking down a dark alley that looks questionable. However, when anxiety responses become exaggerated, uncontrollable, unprecipitated, illogical, and overwhelming, the individual loses a quality of life that wreaks havoc on them and their loved ones. The first line in treating anxiety begins with psychosocial interventions such as mindfulness, breathing exercises, coping skills, and possibly cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT). Training the brain on how to properly and healthily elicit physical responses to anxiety needs addressing (Ströhle et al., 2018).

Anxiety disorders generally begin in childhood and persist into adulthood while affecting women two to three times more frequently than men (Ströhle et al., 2018). Research indicates that magnesium plays a crucial role in mood and brain function because of its role in nerve transmission and the formation of membrane phospholipids. Magnesium supplementation may have a synergistic effect when given with SSRIs and may prove beneficial alone (Botturi et al., 2020). However, more research is necessary. In contrast, the FDA has approved selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and Buspirone as the first lines of defense to treat anxiety disorders such as Generalized Anxiety Disorder (GAD), while benzodiazepines are the second line of defense (Rosenthal & Burchum, 2021).

The psychological sensations of apprehension, fear, and uneasiness accompanied by various physical manifestations such as heart palpitations, trembling, tachycardia, shortness of breath, and weakness can cause an overwhelming sense of dread that can immobilize an individual (The PHARM Guys, 2018). Therefore, when an individual cannot reduce their level of anxiety with their coping mechanisms, concurrent use of medications can assist in calming the brain. This allows the individual to focus, regain composure, and attain a level of calm that allows for logical thought processes to resume (Rosenthal & Burchum, 2021). Achieving therapeutic anxiolytic effects can take weeks when using the FDA-approved antidepressants such as escitalopram, paroxetine, venlafaxine, and duloxetine; even Buspirone can take a week before therapeutic effects are noticeable (Rosenthal & Burchum, 2021). Therefore, when immediate relief is necessary for acute anxiety, the FDA has approved benzodiazepines because of their ability to enhance responses to GABA (Rosenthal & Burchum, 2021). Unfortunately, the abuse potential for benzodiazepines is high, and administering these medications must be done with extreme care and consideration (Speed pharmacology, 2018). Therefore, prescribing Buspirone reduces the potential for abuse because it has the same pharmacological effects without sedation (The Pharm Guys, 2018).

Network meta-analysis of comparisons and efficacy of SSRIs and SNRIs determine that escitalopram, venlafaxine, and duloxetine are more efficacious than other drugs in this class (He et al., 2019). Lexapro represents the SSRI class which blocks the reuptake of serotonin. Effexor represents the SNRI class and inhibits serotonin and norepinephrine reuptake (Speed Pharmacology, 2016). Anxiety directly correlates with low GABA levels, and SSRIs enhance GABA concentrations (Wlodarczyk et al., 2020), suggesting why SSRIs are successful in treating anxiety disorders.

Evidence suggests that anxiety disorders have genetic and environmental components. Even in light of these odds, research depicts that positive environmental factors such as strong social support, secure bonding styles, and effective coping mechanisms can promote resilience (Ströhle et al., 2018). At the same time, magnesium supplementation (Botturi et al., 2020), a ketogenic diet (Wlodarczyk et al., 2020), and ambient temperature and exposure to sunlight (Wortzel et al., 2019) can all have protective benefits against anxiety. However, when these factors are not enough, CBT and pharmacology play a vital role in assisting the individual suffering from anxiety to regain a higher quality of life.

Resources

Botturi, A., Ciappolino, V., Delvecchio, G., Boscutti, A., Viscardi, B., & Brambilla, P. (2020). The role and

the effect of magnesium in mental disorders: A systematic review. Nutrients, 12(6), 1661.

https://doi.org/10.3390/nu12061661

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., Lyu, J., & Ma, X. (2019). Comparative efficacy and

acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A

network meta-analysis. Journal of Psychiatric Research, 118, 21–30. https://doi.org/10.1016

/j.jpsychires.2019.08.009

Pharm Guys. (2018). USMLE Anti-Anxiety / Sleep Pharmacology [Video]. https://www.youtube.com

/watch?v=6EntMogM2UY&list=PLf9PQFwAn2MhnAMPtq75p9AovxHh1azN2&index=1

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses

and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Speed Pharmacology. (2016). Pharmacology – Antidepressants – SSRIs, SNRIs, TCAs, MAOIs, Lithium

(Made Easy) [Video]. https://www.youtube.com/watch?v=T25jvLC6X0w&t=3s

Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy)

[Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety

disorders. Deutsches Aerzteblatt International, 115(37), 611–620. https://doi.org/10.

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Włodarczyk, A., Cubała, W. J., & Wielewicka, A. (2020). Ketogenic Diet: A Dietary Modification as an

Anxiolytic Approach? Nutrients, 12(12). https://doi.org/10.3390/nu12123822

Wortzel, J., Norden, J., Turner, B., Haynor, D., Kent, S., Al-Hamdan, M., Avery, D., &

Norden, M. (2019). Ambient temperature and solar insolation are associated with decreased

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SECOND POST

Generalized anxiety disorder is characterized by excessive anxiety about several events or activities that last 6 months or longer. FDA first-line course for drug treatment include SRIs and buspirone. Second-line choice includes benzodiazepines. Benzodiazepines (alprazolam, diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam) can be used for immediate stabilization when anxiety is severe. SRIs can be used in long-term management. Four antidepressants are approved for GAD: Venlafaxine, duloxetine, paroxetine and escitalopram. Anxiolytic effects develop slowly initial responses can be seen in a week. However, optimal effects take several weeks to develop (Rosenthal & Burhcum, 2021).

SRIs are primarily metabolized in the liver (USpharmacist, 2008). SRIs are mostly metabolized by CYP2D6 in the liver and is excreted in the urine. They work by inhibiting the reuptake of serotonin (Medscape, n.d.). Benzodiazepines benefits drive from enhancing responses to GABA, an inhibitory transmitter. Onset of benefits is immediate, but they can cause sedation. They also have abuse potential and should be carefully considered. Long-term use can also cause physical dependence. These drugs are metabolized by CYP3A4 in the liver (Medscape, n.d.).

Medscape. (n.d.). Alprazolam. Retrieved from https://reference.medscape.com/drug/xanax-niravam-alprazolam-342896#10

Medscape. (n.d.). Paroxetine. Retrieved from https://reference.medscape.com/drug/paxil-brisdelle-paroxetine-342959#10

Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advance practice nurses and physician assistants (2nd edition). St Louis, MO: Elsevier.

USPharmacist. (2008). Overview of Drug-Drug Interactions with SSRIs. Retrieved from https://www.uspharmacist.com/article/overview-of-drugdrug-interactions-with-ssris

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