Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response

Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response

Thank you Wayne for your discussion on the subject.

I agree with you that GAD causes anxiety, fear, and worry in patients which makes it difficult to conduct daily live activities smoothly. The condition can dominate a patient’s life and last for long which can cause detrimental health effects (Shin et al., 2018).  Therefore, early diagnosis of the condition must be done to prevent adverse health conditions. DSM-5 has been approved for the diagnosis of anxiety and other mental disorders. I also agree that the treatment of GAD may take a medication approach or a psychotherapy approach depending on the extremity of the condition in a patient Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response.

PLACE YOUR ORDER HERE

The decision on whether to use psychological or medication treatment is greatly determined by different factors including individual preference, needs, and the severity of the disorder. However, the first treatment approach as discussed in the post is the use of antidepressants such as SNRIs and SSRIs. The drug is mostly considered as it has fewer side effects (Garakani et al., 2020). Additionally, other drugs like benzodiazepine can be used to treat anxiety disorders. However, when using benzodiazepine, a patient must have no prior history of alcohol or substance use.  Regardless of the medication used to treat GAD, commencement must always start with a low dosage and gradually increases until the therapeutic goal is achieved. For example, the treatment for the Caucasian male started at a low dosage of 20mg and was slowly increased to 40mgs which was effective in managing the condition.

Cognitive behavioral therapy has been identified as the most effective psychological approach to GAD. The approach involves the patient confronting the fears and distress they might be facing. Therefore, the approach aims to identify and change thinking patterns in patients that may trigger anxiety (Stefan et al., 2019). By changing their thoughts, patients can better cope with issues in life that may trigger fear, worry, or anxiety.

Generalized anxiety disorder (GAD) is classified in the Diagnostic and Statistical Manual DSM 5 under anxiety disorders and defined as uncontrollable worrying about activities or events lasting six months or longer, commonly with depression as a comorbidity (Ansara, 2020; Rosenthal & Burchum, 2021). This discussion looks at selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) approved by the FDA and are first-line treatments for GAD, which also help to decrease depression (Rosenthal & Burchum, 2021). The pharmacokinetic action of SSRIs and SNRIs is that both block serotonin at the neurons, resulting in reabsorption in the brain. However, SNRIs also inhibit absorption of norepinephrine, which also results in reabsorption by the brain. (Villines, 2020). There are also several non-pharmacologic first-line therapies used for the treatment of GAD, such as relaxation therapy and cognitive behavioral therapy, that can be used alone or in conjunction with pharmacologic treatment (Ansara, 2020).

Reflecting on Observations of Treatment for Generalized Anxiety Disorder

Reflecting on observations of treatment for GAD while working at the Northwest Detention Center (a federal immigration detention facility), the focused patient was diagnosed with GAD with comorbidity of mild depression. Said patient was a healthy 36-year-old Caucasian male recently incarcerated with no known prior medical history and had no risk of alcohol or illicit drug use. This patient was prescribed Paroxetine (Paxil) for a diagnosis of GAD. The initial dosing of Paroxetine, 20 milligrams PO daily with 10 milligrams weekly interval increases, was given until 40 milligrams a day was reached. Although 50% of patients with GAD will not respond to first-line treatment (Ansara, 2020), 40 milligrams for this patient proved therapeutic.

Comparison of Medication used to Treat Generalized Anxiety Disorder

Four antidepressants are approved by the Food and Drug Administration (FDA) for treating GAD; Paxil is one of those four medications due to its efficacy in treating anxiety and depression (Strawn et al., 2018). Other medication classes, such as benzodiazepines like Alprazolam (Xanax) or a non-benzodiazepine non-barbiturate Anxiolytic like Buspirone (Buspar), are also effective in treating GAD. While working in federal immigration facilities, this RN has learned; that when diagnosing and prescribing medication for patients with GAD, it is important to look at multiple factors influencing the patient life. Factors such as differential medical diagnosis, current medications, environment, behavior, diet, age, and gender, as well as ethnicity and cultural beliefs, as all these elements will influence how well a medication will work for your patient and whether said patient will adhere to treatment. These considerations hold true for those patients not incarcerated as well Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response.

ORDER HERE NOW

Benzodiazepines Metabolized by Cytochrome CYP3A4 into metabolites and rapidly absorbed are indicated for acute episodes and are not recommended for long-term treatment of GAD due to the potential of addiction. Alprazolam (Xanax) is rapidly absorbed with a half-life is 11.2 hours and reaches peak plasma concentration around 1 to 2 hours (Ansara, 2020; George & Tripp, 2022). Monitoring a patient’s cardiovascular and respiratory status and the metabolic panel should occur while prescribing this medication to patients. This medication should be avoided in use with a patient with pulmonary disease. Certain types of drugs can affect this medication, i.e., macrolide antibiotics, some antidepressants, some seizure medication, and St. Johns Wort.

Buspirone (Buspar) is a partial agonist on Serotonin 5HT1a as well as a weak antagonist on dopamine autoreceptors D2 and has no effect on GABA receptors. This medication is contraindicated in patients with a history of hypertension, not recommended for use in patients on monoamine oxidase inhibitors (MAOI) and patients receiving reversible MAOI treatment. Although this medication is well tolerated in pediatrics, adolescents, and adults, it is not FDA-approved for pediatric use (Strawn et al., 2018; Wilson & Tripp, 2021). Monitoring should be frequent after starting treatment with this medication and therapeutic effects should be reached at around 3 to 4 weeks. Plasma concentration should be monitored as well and alcohol use will increase CNS effects.

Paroxetine (Paxil) is high protein bound and has a significant first-pass metabolism through the CYPP2D6 system, where it is affected by many polymorphisms and is excreted through the urine (Shrestha et al., 2021). Paroxetine also inhibits its own metabolism; thus, potential doubling of plasma concentration may be experienced after dosage increases. This medication has a few absolute contraindications; pimozide could result in inducing cardiac arrhythmia, concurrent use of MAOIs causing serotonin syndrome, and use with thioridazine also inducing cardiac arrhythmia. This medication is also not recommended for use with tricyclic antidepressants. Moreover, although it was a male patient, this medication was prescribed and not female as an FYI; it should not be prescribed to pregnant or breastfeeding women.

Conclusion

The clinical treatment provided to the 36-year-old Caucasian male patient diagnosed with GAD and mild depression this RN observed and described in this paper was prescribed Paxil due to the environment, formulary constrictions, and medication actions. Paxil was chosen for the patient at a 20mg initial dose with 10mg weekly increases until therapeutic results were achieved. For this patient, 40 milligrams proved to be effective. Paxil is a first-line treatment option and was chosen due to its efficacy in treating both GAD and depression and is one of only four antidepressants approved by the FDA to treat GAD. Benzodiazepines and Buspirone were not chosen due to Benzodiazepine’s addictive properties, and Buspirone was not indicated due to lack of access to alcohol or illicit drugs.

References

Ansara E. D. (2020). Management of treatment-resistant generalized anxiety disorder. The mental health

clinician, 10(6), 326–334. https://doi.org/10.9740/mhc.2020.11.326

George TT, Tripp J. (Updated 2022 May 1). Alprazolam In: StatPearls [Internet]. Treasure Island (FL):

StatPearls Publishing; 2022 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK538165/

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses

and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Shrestha P, Fariba KA, Abdijadid S. (Updated 2021 Dec 9). Paroxetine. In: StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK526022/

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for

generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.

Expert opinion on pharmacotherapy, 19(10), 1057–1070.

https://doi.org/10.1080/14656566.2018.1491966 Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response

Villines Z., (2020 Oct 23). What are the differences between SSRIs and SNRIs? Medical news today

https://www.medicalnewstoday.com/articles/ssri-vs-snri

Wilson TK, Tripp J. (Updated 2022 Mar 16). Buspirone. In: StatPearls [Internet]. Treasure Island (FL):

StatPearls Publishing; 2022 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK531477/

 

References

Garakani, A., Murrough, J., Freire, R., Thom, R., Larkin, K., Buono, F., & Iosifescu, D. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers In Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

Shin, K., LaFreniere, L., & Newman, M. (2018). Generalized Anxiety Disorder. The Cambridge Handbook Of Anxiety And Related Disorders, 517-549. https://doi.org/10.1017/9781108140416.019

Stefan, S., Cristea, I., Szentagotai Tatar, A., & David, D. (2019). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal Of Clinical Psychology, 75(7), 1188-1202. https://doi.org/10.1002/jclp.22779 Comparing and Contrasting Pharmacological Options for Treatment of Generalized Anxiety Disorder Discussion Response