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Anxiety disorder “a chronic condition (click here for help)
Generalized anxiety disorder “a chronic condition characterized by uncontrollable worrying.” (Rosenthal & Burchum pg. 243) Treatment of GAD includes nonpharmacological therapies to go hand in hand with drug interventions. Serotonergic reuptake inhibitors are considered first-line therapy when treatment is selected followed by benzodiazepines as second-line therapy.
SSRIs “are metabolized by the liver by cytochrome P-450 mixed function oxidase microsomal enzymes.” (Cushing, 2021) Typically, SSRIs have a half-life of roughly 20-24 hours, there are variations to that number with a peak of concentration in 2-10 hours. Unlike benzodiazepines, SSRIs have a delayed onset with initial response seen in the first week after starting treatment with optimal results several weeks after start of therapy. SSRIs “block reabsorption of serotonin into the neurons.” (Mayo Clinic, 2019) This allows for more serotonin to be available for transmission of messages between neurons. SNRIs are primarily metabolized through the liver with the half-life ranging from 8-12 hours for the different medications under the SNRI category. Like SSRIs, SNRIs have a delayed onset therefore reassessing the first week of therapy and then again, several weeks later when optimal response is present. SNRIs “block the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain.” (Mayo Clinic, 2019)
Buspirone is another drug that can be used in the management/treatment of generalized anxiety. As with SSRIs and SNRIs, buspirone has a delayed therapeutic effect, therefore not suitable for as needed use. Unlike benzodiazepines, this medication does not influence the CNS and reduces the risk of abuse while utilizing medication for treatment. Buspirone is approved for short-term treatment of anxiety. “The mechanism by which it relieves anxiety has not been established.” (Rosenthal & Burchum pg. 244) Benzodiazepines are the first choice for acute anxiety because of their quick effect, but because of the high risk for abuse patients should be cautioned.
Due to its high risk of relapse use of medications such as SRIs would prove beneficial as buspirone, and benzos are meant to be used for short-term treatment. Just like with several medications there are side effects/adverse reactions to monitor for but with the right education the patient will be familiar with what to monitor for and what to report.(click here for help)