Anxiety A state of tension in response to real or imagined stress or danger situations. Anxiety may manifest itself as Psychic or mental state. Somatic or physical symptoms.

Physical reactions (autonomic changes) tachycardia, sweating, fatigue, weakness, agitation, restlessness, and sleep disturbances

Types of anxiety Obsessive-compulsive disorder (OCD) An anxiety disorder in which people cannot prevent themselves from dwelling on unwanted thoughts, or performing repetitious rituals, such as washing their hands or checking to make sure they turned off the lights.

Panic disorder An disorder in which people have sudden and intense attacks of anxiety in certain situations. Symptoms such as shortness of breath, sweating, dizziness, chest pain, and extreme fear often accompany the attacks.

Phobia An intense, abnormal, or illogical fear of something specific, such as heights or open spaces. Post traumatic stress disorder (PTSD) Recurrent nightmares and memories of mental, physical and emotional distress when exposed to situations that remind them of the trauma.

Generalized anxiety disorder Patients are usually and constantly worried with no apparent reasons. They may be worried about health, money, work. They may experience muscle tension, insomnia, fatigue, headache, inability to concentrate.

Classification 1.Benzodiazepines ( BDZ ). 2.beta-adrenorecoptor blockers 3.Antidepressants 4.5HT agonists. Buspirone 5.5HT reuptake inhibitors. 6.MAO inhibitors

Benzodiazepines Alprazolam-Oxazepam Diazepam- Lorazepam. The first choice for treatment of anxiety. Mechanism of Action Act upon Bzs receptors thus potentiating the effect of GABA receptor / chloride channel complex.

Therapeutic Uses 1.Generalized Anxiety Disorders. diazepam 2. Panic attack Alprazolam (antideppressant) 3. Major depressive disorders. 4. Not for short term mild anxiety

5HT Agonists Buspirone Mechanism of action acts as agonist at brain 5HT1A receptor, also to some extent it acts on DA2 & 5HT2.

Buspirone Pharmacokinetics rapidly absorbed orally. Extensive first pass metabolism to form several active metabolites (CYP3A4). T ½ 2 – 4 h. liver dysfunction  its clearance.

Differences between buspirone and BZs Only anxiolytic No hypnotic effect. No muscle relaxant action. No anticonvulsant properties. Minimal sedation Minimal psychomotor and cognitive dysfunctions Does not affect driving skills. Dependence is unlikely. No withdrawal signs.

Minimal abuse liability. No potentiation of other CNS depressants. Elderly people do not appear to be more sensitive to its action.

Disadvantages Slow onset of action (delayed effect) Not effective in panic disorders. GIT upset, dizziness, drowsiness may occur more frequent than with benzodiazepines.

Uses : As anxiolytic in general anxiety states. Interactions Rifampicin (inducer) Erythromycin (inhibitor)

BETA BLOCKERS Propranolol – Oxprenolol Act by blocking peripheral sympathetic system. Reduce somatic symptoms of anxiety. Decrease BP & slow HR. Social phobia to control anxiety in public situation.

TRICYCLIC ANTIDEPRESSANTS Doxepine- imipramine – desipramine act by reducing uptake of 5HT & NA. Used for anxiety with depression. Effective for panic attacks.

TRICYCLIC ANTIDEPRESSANTS Side effects Atropine like actions α-blocking activity. Sexual dysfunction. Weight gain.

5HT REUPTAKE INHIBITORS Fluoxetine act by blocking uptake of 5HT Orally Metabolized in liver and excreted in kidney. Delayed onset of action (weeks). Inhibitors for CYTP450. Long half life

Uses of Fluoxetine Generalized anxiety disorders Panic disorder OCD depression Side effects - Sexual dysfunctionSleep disturbances - nausea- dry mouth -Seizures.

MONOAMINE OXIDASE INHIBITORS Phenelzine act by blocking the action of MAO enzymes. Used for panic attacks and phobia. Require dietary restriction Avoid wine, beer, fermented foods as old cheese that contain tyramine.

Side effects Dry mouth Constipation Restlessness Dizziness.