Anxiety Disorder and Pharmacology of Anxiety Disorder

Anxiety generally is the fear, worry, and unease about anything or the state around us. A lot of time we might feel fear, and to be sincere, it is normal. If we see something we fear to have a negative result, we have the right to as it is a normal phenomenon but it becomes a disorder when it affects the daily activity of a person(s). Anxiety as a disorder is pervasive fear or anxiousness that could interfere with the normal activity of a person. Anxiety disorder could range from General anxiety disorder (which is an anxious feeling for the majority of a person's day lasting for about 6 months), panic disorder (which are brief, but overwhelming fear, terror, or feeling of independent doom which could be accompanied by shortness of breath, and panic attacks, which reoccur for about 1 month), phobia (irrational fear for objects, things, and activities, to the extent of avoiding them with the thought of it impacting their lives), social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (usually occur as a result of an event, causing difficulty in relaxing, bad dreams, flashbacks, and avoidance of the reminder of the date of the event).

Image

Generalized anxiety disorder

Generalized anxiety disorder is confirmed if patients exhibit symptoms for about 6 months or more. The symptoms will include but are not limited to worry, irritability, fatigue, tension, lack of concentration, and restlessness not about a specific person or thing but just a generalized worry about anything and everything.

Adjustment Disorder

Is caused by a trigger that causes mood symptoms, which could exist for about 6 months. These symptoms could be anxiety or mood symptoms.

Panic Disorder

Panic disorder is diagnosed if the patient exhibits symptoms within 1 month or more. The symptoms include panic attacks, usually associated with palpitations, shortness of breath, impending doom, and tachycardia, and it becomes a disorder when the patient starts to fear, worry, and have a change in behavior with the thought of having another attack.

Specific Phobia

The patient who is diagnosed with a specific phobia has experienced this for about 6 months and more. The phobia is specific to one event or person, such as intense fear of an object. patients are always ego-dystonic.

Agoraphobia

Patients with Agoraphobia have this irrational fear of public spaces or crowds, closed spaces, standing in lines, and commuting by public transport. It causes people to be scared of being in public and this becomes a disorder when they are scared of going out so they do not be amongst people (Co-morbid with panic disorder).

Social Anxiety Disorder

Patients with this type of disorder have this specific fear of embarrassment in a social situation.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder can be explained as a disorder that occurs as a result of a patient experiencing a life-threatening event that leads to trauma Symptoms such as hyperarousal, avoidance symptoms, intrusive symptoms (nightmare, or flashback around the event), and cognitive changes in the person. Trauma existing around a month or more. When the trauma last for less than a month, it is regarded as Acute Stress Disorder while for Post traumatic Stress Disorder (PTDS)

Obsessive Compulsive Disorder

Patients that suffer from OCD have this intrusive ideas (obsession) which leads to distress. They can stop engaging in their obsession so they begin to have a repetitive ritual of the obsession (Compulsions). Patients with obsessive compulsive disorder get anxious and worried over an obsession where they get compulsion to continually satisfy the obsession which gives partial relief but the patients keeps going through the process over and over again.

Image

Anxiety disorder has to do with the overactivation of the limbic system made up of the Limbic cortex (Cingulate gyrus, Parahippocampal gyrus), Hippocampal formation (The dentate gyrus, Hippocampus), and Subicular Complex (Amygdala, Septal area, and Hypothalamus). Let me quickly dive into anxiety disorder in full. The Amygdala is involved in fear and anger, and when sensory information is passed through the thalamus to the amygdala it would respond with fear or panic response, sending the signals to the nearby regions. The prefrontal cortex is responsible for decreasing or shutting done response to fear when it is not genuine. There are several neurotransmitters involves in triggering the response to anxiety, they include Gamma Aminobutyric Acid (GABA), Serotonin, Norepinephrine, Sympathrtic response (Epinephrine), and stress hormone (Cortisol), Dopamine, Glutamate, and Acetylcholine.

When patients have Anxiety disorders, nonpharmacologic therapies can be introduced, to cope with the anxiety. Patients should be encouraged to explore the cause of the anxiety in a nonpharmacological method, while exploring pharmacology as well. The non-pharmalogical therapies include Counseling, Congnitive behavioural therapy, Biofeedback technique, and meditation.

On the Pharmacological method of treating anxiety disorders, we have to understand that Anxiolytics, Sedatives, and Hypnotics can be used. Anxiolytics are drugs that have the ability to relieve anxiety, Sedatives are drugs that sedates the patients, giving them the ability to relax, while Hypotics have the ability to induce sleep. These drugs are referred to as Central Nervous System (CNS) depressants as they lower the activity of the central nervous system. These drugs can be the same but given at different doses. Most CNS depressant can cause physical and psychological dependence, and they could lead to respiratory depression, memory impairment, amnesia, confusion, and oversedation can occur.

Agents used to treat anxiety and sleep disorders can be categorized into four classes Benzodiazepines (Alprazolam), Barbiturates (CNS depressant which is almost not used), Selective Serotonin reuptake inhibitor Antideprepresant (Paroxetine), and Atypical Anxiolytic and hypnotic drugs which are non-barbiturate, and non-benzodiazapine (Buspirone).

Benzodiazepines
Benzodiazepine drugs include Alprazolam (Xanax), Diazepam (Valium), Midazolam, and Lorazepam (Ativan). It increases the effect of GABA at inhibitory GABA-A receptors. GABA is a known inhibitory neurotransmitter in the brain, that causes hyperpolarization of the cell (by allowing chlorine ion into the cell) thereby inhibiting neurotransmission in the brain making the neurons less likely to fire. It can be used as an Anxiolytic to treat general Anxiety Disorder (GAD), panic disorder, PTSD, Insomnia, Seizure Disorder, and it is used to treat muscle spasm. They act faster than SSRIs, and are a drug of choice for short term treatment of anxiety.
Barbiturates
Similar to Benzos, Barbiturates binds to GABA channel intensifying the effect of GABA, and it allows for chlorine ion into the cell for a longer period rather than in a shorter period in case of Banzos. It is a powerful CNS depresant primarily prescribed as a sedative, hypnotic, anesthetic, and also has antiseizure effects. Example of Barbiturates drugs are Secobarbital, and Pentobarbital.
Non-barbiturate, and non-benzodiazapine
These drugs are used to treat Insomnia, anxiety, PTSD, OCD, and seizure disorders. It is structurally unrelated benzodiazepines or barbiturates. It affects serotonin and dopamine receptors. Adverse effect of taking this drug includes mild nausea, dizziness, lightheadedness, agitation, constipation, and in few cases suicidal ideation.
Selective Serotonin reuptake inhibitor
These drugs block the reuptake of serotinin back into the presynaptic terminal. It leaves more serotinin in the synapes. Example of drugs includes Paroxetine, Sertraline, Escitalopram, Fluoxetine, and Fluvoxamine. It is used to treat Anxiety Disorder, and depression.