What medications are considered first-line best practices for treating anxiety? How long can they expect these medications to take full effect? Alternative to use?
Selective serotonin reuptake inhibitors (SSRIs) are recommended as a first-line treatment for anxiety disorders (Bandelow et al., 2017). They increase serotonin levels by blocking the serotonin transporter (SERT) which helps to reduce anxiety (Stahl & Muntner, 2021). These drugs can be used long-term due to better tolerability, less sedation, and less chance of abuse or withdrawal (Bandelow et al., 2017). A study that was conducted by Jakubovski et al (2018), also reported that serotonin-norepinephrine reuptake inhibitors (SNRIs) are also the first-line pharmacological treatment for anxiety disorders, but higher doses of these medications are not needed to relieve anxiety. Therefore, the pharmacotherapeutic treatment is somewhat a matter of professional expertise and what the provider is comfortable with prescribing.
What therapy would be indicated for someone with anxiety?
Cognitive behavior therapy (CBT) can be indicated for someone with anxiety. It can be used to examine negative thoughts that contribute to anxiety symptoms and replace those thoughts with more positive realistic thoughts. This type of therapy approach is to help clients identify irrational thoughts and help them analyze their negative beliefs. Furthermore, the use of an SSRI with CBT can reduce the activity in the amygdala and insula which is responsible for pain and emotional perception, and addictive behaviors (Gorka et al., 2019).
What do you need to assess before prescribing a benzodiazepine? What special considerations should be given and discussed with the patient?
Benzodiazepines may be used in the management of diseases such as insomnia or anxiety. However, the use of benzodiazepines can result in respiratory depression due to its effects on the central nervous system hence patients should be educated on its use and contraindications. Benzodiazepines are recommended for short-term pharmacotherapeutic treatment use due to the significant risk of dependence. Long-term benzodiazepines should be avoided if possible due to the risk of dependence, possible abuse, and cognitive decline (Stahl, 2017). Moreover, patients should be tapered off long-term use if they can tolerate the discontinuation without severe withdrawal. According to Takaesu et al (2019), patients taking benzodiazepines are at increased risk of cognitive function decline, falls, as well as dependence, and tolerance. That being said, benzodiazepines should not be considered first-line due to their high potential for abuse.
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