Anti-Anxiety drugs

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines are a group of medications that can help reduce anxiety and make it easier to sleep.

1. ANTI-ANXIETY
DRUGS
VIJAY SALVEKAR
DEPT. OF PHARMACOLOGY
GRY INSTITUTE OF PHARMACY

2. Anxiety
Unpleasantstateoftension,
apprehension[fear]oruneasiness
[discomfort]thatseemstoarise
fromanunknownsource.
Usuallyassociatedwithsomatic
symptomstachycardia,sweating,
tremor,palpitation,hyperapnea,
etc

4. ANXIETYDISORDERS
o
PanicDisorder-suddenperiodsof
intensefearthatmayinclude
palpitations,sweating,shaking,
shortnessofbreath,numbness,ora
feelingthatsomethingterribleisgoing
tohappen.

6. 2.GeneralizedAnxietyDisorder-adisorder
characterizedbyexcessiveorunrealistic
anxietyabouttwoormoreaspectsoflife
(work,socialrelationships,financialmatters,
etc.),oftenaccompaniedbysymptomssuch
aspalpitations,shortnessofbreath,or
dizziness

8. PhobicDisorders-intense,persistent,
andrecurrentfearsofcertainobjects
(suchassnakes,spiders,orblood)or
situations(likeheights,speakinginfront
ofagroup,andpublicplaces).

10. Stress Disorders-
mentalhealthdisordersthatarearesultofan
atypicalresponsetobothshortandlong-term
anxietyduetophysical,mental,or
emotionalstress.Thesedisorderscaninclude,
butarenotlimitedto
obsessive-compulsive disorderand
posttraumaticstressdisorder.

12. oObsessive-Compulsive Disorder-
Apsychiatricdisordercharacterizedbyobsessivethoughts
andcompulsiveactions,suchascleaning,checking,
counting,orhoarding.(OCD),oneoftheanxietydisorders,
isapotentiallydisablingconditionthatcanpersist
throughoutaperson'slife.Theindividualwhosuffers
fromOCDtrappedinapatternofrepetitivethoughtsand
behaviorsthataresenselessanddistressingbutextremely
difficulttoovercome.OCDoccursinaspectrumfrommild
tosevere,butifsevereandleftuntreated,candestroya
person'scapacitytofunctionatwork,atschool,orevenin
thehome.Treatmentincludestalktherapy,medicationor
both.

17. Anti anxietydrugs
oMostlymildCNSdepressants
oControlthesymptomsofanxiety,
producearestfulstateofmind
withoutinterferingwithnormal
mentalorphysicalfunctions.

18. Classification
1.Benzodiazepines: Diazepam ,Chlordiazepoxide
Oxazepam, Lorazepam, Alprazolam, Flurazepam
2)Azapirones:Buspirone ,Gepirone,Ipsapirone
3)Sedative Antihistaminic:Hydroxyzine
4)Beta blockers:Propranolol
5)Others: selective serotonin reuptake inhibitor[SSRIs]
6)tricyclicantidepressant. [TCA]
7)MAO-inhibitors
8)Serotonin-norepinephrinereuptake inhibitos[SNRI]
(venlafaxine)
Meprobamate ,Clonidine,

19. Benzodiazepines
Site of action: mid brain ,ascending
reticular formation ,&limbicsystem
MOA:
By post synaptic inhibition through
BZDreceptor

21. PK ofBenzodiazepines
Givenorally ,iv & im (lorazepam &temazepam)
Oralabsorptiongood
PhaseI&phaseIImetabolism
Lorazepam & Oxazepamnoactivemetabolite
short acting

22. ADR
Sedation
Lightheadedness
Cognitiveimpairment
Vertigo
Confusion
Appetite& Wtgain
Alterin sexualfunction
Dependence

23. Advantages ofBZD
High therapeuticindex
Do not affect respiration orcardiovascular
function
Nomicrosomalinduction
Specific BZD antagonist Flumazenilis
available

24. CHLORDIAZEPOXIDE
First BZD used as an antianxiety
agent
Produce smooth long lastingeffect
Preferred in chronicanxietystates
T1/2 :5-15hours
Dose : 20-100mg

25. OXAZEPAM
Hepatic metabolism is lesssignificant
It is preferred in the elderly and those with
liverdisease
Short duration ofaction
Usedinshortlasting anxietystate

26. LORAZEPAM
Oral&IMadministration
No activemtb
Short acting preferred inelderly
Used in short lasting anxiety ,Panic, OCD,
tensionsyndrome
Dose: 1 -6mg/day

27. ALPRAZOLAM
Anxiolytic+ antidepressant
High potencyanxiolytic
Useful in anxiety associated with
depression
Lessdrowsiness
Dose :0.25-0.5mg BD orTDS

28. AZAPIRONES
Buspirone , Gepirone,Ipsapirone
MOA:
Selective agonistic action on5HT-1A
receptor
Weak D2 blocking action –no
antipsychotic or extrapyramidalS/E
Site ofaction:
Dorsal raphe seretoninergicneurones

29. Azapirones
Advantages:
Nosedation
No tolerance orphysical
dependence
No abuseliability
Lesspsychomotor
impairment
Does not potentiate the
effect of other CNSdrugs
Disadvantages
Slow onset ofaction
not suitable foracute
anxiety
Requires thricedaily
admin

30. PK
given orally, rapidlyabsorbed
Extensive first passmetabolism
Excreted through urine andfaeces
ADR
Dizziness ,headache,Nausea
Tachycardia , PupillaryConstriction
DOSE:5-10mg OD-TDS

31. SSRI inAnxiety
Preferred in chronic anxietystates
Startedinlowdose
Slow onset ofaction
Started along withBZD

32. Betablockers
oPropranolol :reduce the symptoms of
anxiety
oThey do not affect thepsychological
symptoms (worry ,tension,anxiety)
oUsed for performance/situationalanxiety
oDose:20-40mg2hr beforethe
performance

33. Different type of anxiety and itsand
itsmanagement
Generalized Anxiety Disorder: persistent excessive,
unrealistic worry associated with somaticsymptoms.
Acute phase –Benzodiazepines arepreferred
Rapid onset ofaction
Eg:lorazepam,Oxazepam
Not ideal for long term treatment due toabuse
liability & development oftolerance
For long term use : Buspirone ,SSRIs.

34. Obsessive-CompulsiveDisorder
Obsessive thoughts and compulsive behaviors thatimpair
everydayfunctioning
Treatment
oTCA (clomipramine)poorlytolerated
oSSRI
•Fluoxetine (5–60mg/d),
•fluvoxamine (25–300mg/d),
•sertraline (50–150mg/d)
oBuspirone
oBZD

35. PanicDisorder:
Recurrent and unpredictable panic
attacks, with intense discomfort and fear
of impending doom ordeath.
Treatment
•SSRIs lowdoses
•Eg: 5–10 mg fluoxetine, 25–50 mg sertraline,
10 mgparoxetine

36. PhobicDisorders
Persistent fear of objects or situations, exposure to
which results in an immediate anxiety reaction. The
patient avoids the phobic stimulus, and this
avoidance usually impairs occupational or social
functioning.
Treatment
o Beta blockers:Propranolol20–40 mg orally 2 hbefore
theevent(performanceanxiety)
oSSRIs
oMAOinhibitors

37. StressDisorders
Anxietyfollowingexposure to extreme traumatic events.
The reaction may occur shortly after the trauma (acute
stress disorder) or be delayed and subject to recurrence
(PTSD) . In both syndromes, individuals experience
associated symptoms of detachment and loss of
emotionalresponsivity.
Treatment
oBenzodiazepinesand supportive/expressive
psychotherapy
oSSRI
oMAO inhibitors

38. Futureprospects
Cholecystokinin (CCK)antagonists
Alpiderm: partial agonist onBZD
receptor
Corticotropin-releasingfactor (CRF)
antagonists
Neuroactivesteroids

39. THANKYOU