Antianxiety Treatment Guidelines for Non-psychiatric Clinicians

Chung, Young Cho; Lee, Kang Joon

Abstract

The anxiety disorders make up one of the most common groups of psychiatric disorders. Anxiety is an alerting signal ; it warns of impending danger and enables a person to take measures to deal with a threat. Three major schools of psychological theory-psychoanalytic, behavioral, and existential-have contributed theories about the causes of anxiety. Many drugs are effective in managing distressing signs and symptoms associated with anxiety disorders. As the symptoms are controlled by medication, patients are reassured and develop confidence that they will not be incapacitated by the disorder. Benzodiazepines are useful in panic disorder, phobias, and agitation. In general, benzodiazepines act as hypnotics at high doses and as anxiolytics or sedatives at low doses. The benzodiazepines have become the sedative-hypnotic drugs of first choice because they have a higher therapeutic index and significantly less abuse potential than do many of other sedative-hypnotics. The most common adverse effect of benzodiazepines is drowsiness. Some patients also experience dizziness and ataxia. The most serious adverse effects of benzodiazepines occur when other sedative substances are taken concurrently. When benzodiazepines are used for long periods, they usually cause significant tolerance, dependence, or withdrawal effects. Overdoses with benzodiazepines alone have a predictably favorable outcome. The benzodiazepines should be started at a low dosage, and the patient should be informed about the drug's sedative properties and abuse potential. Serotonin-specific reuptake inhibitors (SSRIs) have a much more favorable profile of adverse effects and have significantly broadened the horizon for pharmacological treatment of anxiety disorder. Three fourths of patients experience no adverse effects at low starting doses, and doses may be increased relatively rapidly in these patients. In the remaining one fourth of patients, most of the SSRIs' adverse effects appear within the first 1 to 2 weeks, and they generally subside or resolve spontaneously if the drugs are continued at the same dose.