• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • Home
  • About
  • Consumer Info
  • Guideline Notes
  • Medicine and Media
  • Pharmacogenomics
  • Visit My Etsy Store

Digital PharmD

Informatics in Pharmacy

Anxiety, OCD and PTSD

August 13, 2018 By Dr. G, PharmD

Print Friendly, PDF & Email

Generalized Anxiety Disorder (GAD):

  • 6 months or more of excessive worry or anxiety.
  • OCD – intrusive thoughts that can not be controlled
  • PTSD: trauma related to avoidance of stimuli.
  • Benzos are the first line therapy in anxiety.  Can cause tolerance or dependence.  Abrupt discontinuation can lead to withdrawal.   Treat for 3-4 weeks until trial for an antidepressant is complete.
  • SSRIs are also effective, as is venlafaxine, duloxetine, and TCAs.  Buspirone is controversial.  Venlafaxine is the agent of choice because it also helps with vasomotor symptoms.
  • Misc agents: Beta-blockers can block peripheral symptoms.  MAOIs can treat panic with atypical depression.  Hydroxyzine’s sedating effects can reduce the physical symptoms of anxiety
    Augmentation with quetiapine, olanzapine or risperidone can be tried.

Benzodiazepines:

BenzodiazepineOnset of ActionPeak Onset (hrs)Half-life
parent (hrs)
Half-life
metabolite (hrs)
Comparative
Oral Dose
Long Acting
ChlordiazepoxideInt. (po)2-4(po)5-303-10010 mg
DiazepamRapid (po, IV)1(po)20-503-1005 mg
FlurazepamRapid0.5-2inactive47-10030 mg
Intermediate  Acting
AlprazolamInt.0.7-1.66-20–0.5mg
ClonazepamInt.1-418-39–0.25mg
LorazepamInt. (po),
Rapid (sl, IV)
1-1.5 (po)10-20–1mg
OxazepamSlow2-33-21–15mg
 TemazepamSlow 0.75-1.510-20– 30mg
Short Acting
Midazolam Most  Rapid IV0.5-1 (IV )1-4––
TriazolamInt.0.75-21.6-5.5–0.5mg

IV BZDs:

DrugDiazepamLorazepamMidazolam
Onset (m)2-55-202-5
Duration (h)2-44-61-2
Prolonged in renalyesnoyes
Prolonged in hepaticyesnoyes
T 1/2 (h)24-12010-201-10
Active metabolitesyesnoyes
CYP 3A4 Interactionyesnoyes
Hypotensionyesnono
Thrombocytopeniayesmaybeno
Propolyne glycol
toxicity
noyesno

ALOT are better for elder and renal pts (alprazolam, lorazepam, oxazepam, temazepam)

Panic disorders:

  • Antidepressants, BZDs.
  • Don’t use buspirone, Beta blockers, antihistamines, antipsychotics, bupropion or trazodone.
  • Cognitive behavioral therapy (CBT) can be effective.  Start on low doses of antipsychotics.

Obsessive Compulsive Disorder (OCD):

  • SSRIs, cognitive behavioral therapy secondary to drugs, augmentation with haloperidol or a second-generation antipsychotic (olanzapine, quetiapine or risperidone) may help.

Post-traumatic Stress Disorder (PTSD):

  • Psychotherapy, SSRIs can be used as an adjunct
  • Can treat with prazosin for nightmares, anticonvulsants (valproic acid, carbamazepine, lamotrigine, topiramate) for anger, aggression, and depression or atypical antipsychotics (olanzapine, quetiapine, risperidone) for psychotic symptoms.  BZDs for sleep

Seasonal Affective Disorder (SAD):

  • CBT most cost-effective. Can also use SSRIs, clonazepam, gabapentin and pregabalin

Phobias:

  • No meds help, desensitization is the only therapy.

Filed Under: Neurology Tagged With: anxiety, Benzodiazepine conversion

Primary Sidebar

Newsletter

More to See

What You Need to Know About the 2022 Avian Influenza Outbreak

March 20, 2022 By Dr. G, PharmD

Endocarditis Guideline Review

February 24, 2022 By Dr. G, PharmD

Sinus Troubles: When Should I See My Doctor

January 5, 2022 By Dr. G, PharmD

Tags

acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020

Footer

Medical Disclaimer

The medical information on this website is provided “as is” without any representations or warranties, express or implied. GoPharmD makes no representations or warranties in relation to the medical information on this website.

GoPharmD does not warrant that:

  • the medical information on this website will be constantly available, or available at all; or
  • the medical information on this website is complete, true, accurate, up-to-date, or non-misleading.
  • You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.
  • If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider.

Recent

  • Smoking
  • What You Need to Know About the 2022 Avian Influenza Outbreak
  • Endocarditis Guideline Review
  • Sinus Troubles: When Should I See My Doctor
  • Common Pharmacogenomic SNPs and Interactions

Search

Tags

acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020