Drugs Used in Anxiety

First of all, let us understand what we really mean by 'anxiety'. In medical terminology, the meaning of this word is somewhat different from what it is used for in everyday life. Anxiety is not the same as fear. The situation of fear is of short duration: for example, 1) a fast driving car almost about to hit you; 2) a ferocious dog chasing you; 3) you are getting late for an important appointment; 4) you have to appear for an examination or interview. In all these situations the fear is short-lived. But in modern life, one faces several problems daily, of which some are persistent. These hazards or problems may be real or imaginary, for example, fear of losing a job. In either case the danger may last for weeks or months.

Hydroxyzine (Atarax, Vesparax)

This drug provides symptomatic relief in states of anxiety. Besides anti-anxiety action, it also has antiemetic (preventing vomiting) and anti-allergic properties. It has a significant sedative action that lasts for a short period. It is also useful in treatment of insomnia, urticaria (hives) and drug allergy.

Dosage: Hydroxyzine is given orally in a dose of25 mg, 3 to 4 times daily.

Adverse Effects: It is a relatively weak anti-anxiety agent with few harmful effects. Occasionally, it may cause headache, nausea, and dryness of the mouth. Prolonged use may cause drug dependence. The drug enhances the sedative action of morphine and barbiturates.

Buspirone (Anxipar, Buscalm, Buspin)

This has all the properties possessed by the benzodiazepines but has least sedative action and does not produce cognitive impairment. No tolerance or dependence has been described. It does not have muscle relaxant effect. It is found to be useful in mild to moderate generalized anxiety.

Dosage: The Initial dose should be 5 mg, three times a day which can be gradually increased even upto 60 mg per day.

Adverse Effects: In high doses this drug can cause nausea, light headedness, headache and dizziness.

Other Anxiety Disorders

Phobia an unrealistis anxiety or feel in a particular situation is called phobia.

Agoraphobia is the fear of open-spaces or marketplaces. It waxes and wanes and may disappear without treatment. Psychotherapy, familiarization and use of antidepressants (see chapter 'Drugs Used in Mental Depression') are helpful.

Social phobia includes stage phobia (public speaking, acting/performance), phobia in using public bathrooms and giving witness etc. Such people develop the manifestations of anxiety and fear in social situations. Many of them are shy and timid by nature since early in life. Psychotherapy, exposure treatment and some drugs (such as sertraline, propranolol or clonazepam) may help.

Obsessive compulsive disorder is a disorder in which a person gets recurrent and unwanted ideas or impulses which are bizarre (obsessions). There is an associated compulsion to do some act repeatedly in response to obsessions e.g., repeated hand washing to avoid infection. This requires proper evaluation and treatment. The treatment includes behaviour therapy and use of antidepressants (particularly clomipramine and fluoxetine)

Panic attacks are characterized by sudden appearance of anxiety and physical manifestations such as breathing difficulty, palpitation, tremor, choking, chest discomfort and fear of dying. Treatment includes psychotherapy and use of antianxiety and/or antidepressant drugs. Diazepam, alprazolam, fluoxetine and imipramine have been found to be effective. Sometimes parenteral (intravenous/intramuscular) diazepam is given under supervision to avoid respiratory depression.

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