Discussion Post Reply GAD Medications Paper
Discussion Post Reply GAD Medications
Hello Colleague. Thank you for the informative discussion on the clinical features, implications, pharmacological, and psychotherapy treatment of GAD. I agree with you that it is the degree of anxiety one experiences, the level to which it affects a person, and the person’s response to the anxiety that determines whether the anxiety will be positive or negative. In addition, to your discussion, I have learned that the focus of the anxiety in GAD is not restricted like in other psychiatric anxiety disorders, such as panic attacks, and obsessive-compulsive disorder (Strawn et al., 2018). In GAD, an individual has multiple worries, which usually shift over time. The common worries include occupational and family responsibilities, school, health, money, safety, and chores. The course of GAD is mostly fluctuating and chronic and exacerbates during stress. Besides, most patients with GAD have one or more other comorbid psychiatric disorders, such as major depression, social phobia, specific phobia, and panic disorder (Strawn et al., 2018). The diagnosing criteria for GAD state that the anxiety and worry should be accounted for by substance use or another medical disorder such as hyperthyroidism.
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In the treatment of GAD, Benzodiazepines are effective in small to moderate doses. However, clinicians should be cautious of sustained use as it may cause physical dependence. From research, I have learned of one strategy, which involves beginning with concomitant use of a benzodiazepine and an antidepressant (Slee et al., 2019). Once the antidepressant becomes effective, the benzodiazepine is tapered. Buspirone is also effective, but it often requires moderately high doses of more than 30 mg/day and at least two weeks before it begins to show effect.
References
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. The Lancet, 393(10173), 768-777. https://doi.org/10.1016/S0140-6736(18)31793-8
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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
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Peer Post:
Anxiety is an emotion that everyone experiences. In healthy doses, it can be what motivates a person. It is all about the amount of anxiety one experiences, to what degree it affects them, and how they respond to it that factor in determining whether anxiety is positive or negative in one’s life. When that emotion of anxiety becomes too overwhelming, it can interfere with one day to day living, which becomes a problem. We live in a society learning to accept that our mental health is as important as our physical health, so it is essential to identify and treat it the same way.
Generalized Anxiety Disorder (GAD) is defined as “a chronic condition characterized by uncontrollable worrying” (Rosenthal & Burchum., 2021). Symptoms that are commonly seen with GAD are Persistent worrying about unrealistic, overthinking plans, focusing on the worst-case outcomes, fear, and the inability to relax accompanied by physical symptoms that can include tachycardia, tense muscles, trembling, sweating, trouble sleeping, or even nausea, diarrhea (Generalized Anxiety Disorder – Symptoms and Causes, 2022.) Symptoms of anxiety and the degree it affects one’s life can vary from person to person, and so can successful treatment of GAD.
Pharmacogenetics also plays a role in people with GAD, and it commonly runs in families. Pharmacokinetic gene variations play a significant role in how one responds to the treatment because it will determine how the body absorbs, distribution, metabolizes and excretes the drug treatment. For example, the genetic variant UGT2B15 can act as an intermediate metabolizer and subsequently increase serum levels of some benzodiazepines (RPh, 2022.). The CDC did a survey and found that adults aged 18-29 experienced the highest amount of moderate to severe symptoms from anxiety and that women are more likely than men to suffer from severe anxiety (Products – Data Briefs – Number 378- September 2020, 2020).
Generalized anxiety disorders can be managed non-pharmacologically with supportive therapy, cognitive therapy, and relaxation training (Rosenthal & Burchum., 2021). These are often the most effective ways to gain long-term management of their disorder; however, it takes a person willing to dedicate time and effort to make this treatment successful. It can also be a more expensive route because you may be left paying to see a therapist once or twice a week for months at a time. This treatment consists of constant work on the patient even once their GAD is considered controlled.
GAD’s pharmacological treatment is commonly used since it is often less expensive and seems a quick fix. The FDA has approved SSRIs, SNRIs, and buspirone as the first-line drug choices for GAD (Rosenthal & Burchum., 2021). The issue with these medications is that the onset can take weeks to months, and in that time, GAD and mood swings can often get much worse. The second-line treatment option for GAD is benzodiazepines (Rosenthal & Burchum., 2021). These are the more “quick fix” that people often prefer; however, the abuse potential for this class is extremely high. Everybody is different, and the treatment plans will vary accordingly. Ideally, it would be to combine nonpharmacological management such as counseling with an SSRI and see if GAD symptoms improve. It may take weeks or months to see if these medications are working, and when they don’t, it can be just as emotionally challenging to taper off one SSRI and begin a different one. When prescribing benzodiazepines, you assess factors such as past drug abuse or dependence because you don’t want to set your patient up for failure. Lastly, extended-release benzodiazepines can provide patients with the same quick relief with less risk since as many noticeable sides don’t accompany them as drowsiness.