By: Saurabh Narkhede and Patrick Simon
Anxiety : Anxiety is a normal reaction to stress. The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict.
Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness and fatigue.
Psychological concomitants include feelings of impending danger, powerlessness, apprehension and tension.
Five major types of anxiety disorders
1.
Generalized Anxiety Disorder: an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
Sign & Symptoms: physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes.
2.
Obsessive-Compulsive Disorder (OCD): an anxiety disorder and is characterized by recurrent, unwanted thoughts
(obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away.
Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
Sign & Symptoms: plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals and obsessed with germs or dirt, and wash their hands over and over etc…
3.
Panic Disorder: an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
Sign & Symptoms: feelings of terror that strike suddenly and repeatedly with no warning. Pounding heart and feeling sweaty, weak, faint, or dizzy.
4.
Post-Traumatic Stress Disorder (PTSD): an anxiety disorder that some people get after seeing or living through a dangerous event.
Sign & Symptoms: grouped into three categories: Re-experiencing symptoms (Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating; Bad dreams; Frightening thoughts.) Avoidance
symptoms (Staying away from places, events, or objects that are reminders of the experience; Feeling emotionally numb; Feeling strong guilt, depression, or worry; Losing interest in activities that were enjoyable in the past; Having

trouble remembering the dangerous event.) Hyperarousal symptoms (Being easily startled; Feeling tense or “on edge”;
Having difficulty sleeping, and/or having angry outbursts.)
5.
Social Phobia (or Social Anxiety Disorder): an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation — such as a fear of speaking in formal or informal situations, or eating or drinking in front of others — or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.
Sign & Symptoms: a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions and blushing, profuse sweating, trembling, nausea, and difficulty talking
Medications:
Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy.
Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy.
Drug classes used to treat anxiety: antidepressants, selective serotonin reuptake inhibitors (SSRIs), Tricyclics, Monoamine oxidase inhibitors (MAOIs), Beta-blockers, and anti-anxiety drugs.
TOP 20 DRUGS TO TREAT ANXIETY:
Brand Name Generic
Atarax hydroxyzine
Ativan lorazepam
Drug Class
Antihistamine/
Piperazine/
Respiratory agent
Antianxiety/
Benzodiazepine
Mechanism of Action
Hydroxyzine hydrochloride is a rapid-acting true ataraxic with probable action of suppressing activity in key locations of the central nervous system's subcortical area. It also exerts bronchodilating, antispasmodic, antihistaminic, analgesic and antiemetic effects
Lorazepam, a benzodiazepine clinically used as antianxiety, sedative and anticonvulsant agent, binds highly to the gamma-aminobutyric acid
(GABA)-benzodiazepine receptor complex without displacing GABA. The drug binds to its specific attachment site to improve GABA's
Dosage
Anxiety: 50 to 100 mg
ORALLY 4 times daily
Anxiety: 50 to 100 mg
IM immediately, then every 4 to 6 hr as needed
Initial, 2 to 3 mg/day
ORALLY divided into 2 to 3 daily doses
Maintenance, 2 to 6 mg/day ORALLY divided into 2 to 3 daily doses; dose may vary from 1 to 10 mg/day
Common Side Effects
Gastrointestinal: Xeros tomia
Neurologic: Headache,
Somnolence
Neurologic: Asthenia,
Dizziness, Sedated,
Unsteadiness present
Psychiatric: Depression

Buspar
Compazine buspirone HCl prochlorperazine
Antianxiety/
Azaspirodecane dione
Antiemetic/
Phenothiazine/
Piperazine attraction to its own receptor site on the GABAbenzodiazepine receptor complex. It exerts tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular system
Buspirone hydrochloride is an antianxiety agent with an unknown mechanism of action.
It exhibits high affinity for serotonin (5-HT(1A)) receptors, moderate affinity for brain D(2)dopamine receptors and no significant affinity for benzodiazepine receptors. It has no effect on GABA binding
Anxiety: 5 mg ORALLY
2 to 3 times a day OR
7.5 mg ORALLY twice a day; may increase the dosage by 5 mg/day every 2 to 3 days as needed (usual dose 20 to 30 mg/day (2 to 3 divided doses), MAX dose 60 mg/day) tablets, 5 mg ORALLY
3-4 times daily; do not administer in doses of more than 20 mg/day or for longer than 12 weeks (max dose 150 mg/day) spansule capsules, 15 mg ORALLY on arising
OR 10 mg every 12 hr; do not administer in doses of more than 20 mg/day or for longer than 12 weeks (max dose 150 mg/day)
injection, 10 to 20 mg
IM every 2 to 6 hours as needed, multiple doses are seldom necessary
Gastrointestinal: Naus ea
Neurologic: Asthenia,
Confusion, Dizziness,
Excitement, Headache,
Numbness
Ophthalmic: Blurred vision
Psychiatric: Feeling angry, Feeling nervous,
Hostile behavior
Cardiovascular: Hypote nsion, Orthostatic hypotension
Dermatologic: Diminish ed sweating,
Photosensitivity
Gastrointestinal: Consti pation, Xerostomia
Neurologic: Akathisia,
Dizziness, Drug-induced tardive dystonia,
Dystonia,
Extrapyramidal disease,
Parkinsonian,
Somnolence, Tardive dyskinesia
Ophthalmic: Blurred vision, Epithelial keratopathy, Eye / vision finding, Retinitis pigmentosa
Respiratory: Nasal congestion

Cymbalta
Dilantin
Effexor XR
Duloxetine HCl phenytoin venlafaxine
Antidepressant/
Serotonin/Norep inephrine
Reuptake
Inhibitor
Anticonvulsant/
Hydantoin
Antidepressant/
Phenethylamine/
Serotonin/Norep inephrine
Reuptake
Inhibitor
Duloxetine HCl, a selective serotonin and norepinephrine reuptake inhibitor, exerts its antidepressant and pain inhibitory actions by potentiating the serotonergic and noradrenergic activity in the CNS. It has no significant affinity for adrenergic, dopaminergic, cholinergic, opioid, glutamate or histaminergic receptors in vitro and does not inhibit monoamine oxidase
Phenytoin is an antiepileptic drug that possibly enhances sodium efflux from neurons of the motor cortex. This cellular event tends to stabilize the threshold against hyperexcitability that results from excessive stimulation or environmental changes capable of reducing membrane sodium gradient. Posttetanic potentiation at synapses is then reduced preventing cortical seizure foci from detonating adjacent cortical areas initial, 60 mg ORALLY once daily, may start at
30 mg ORALLY once daily for 1 week and then titrate up to 60 mg
ORALLY once daily; may increase by increments of 30 mg once daily; MAX 120 mg ORALLY once daily
100 mg (2 tablets) 3 times daily, usual maintenance dose 300 to 400 mg/day (MAX dose 600 mg/day)
Venlafaxine hydrochloride is an antidepressant agent that potentiates the neurotransmitter activity in the central nervous system (CNS). It also inhibits neuronal serotonin, norepinephrine and dopamine reuptake initial, 37.5 to 75 mg/day ORALLY
(single dose); may increase dosage by 75 mg/day every 4 days to a max dose of 225 mg/day
Dermatologic: Diaphore sis
Gastrointestinal: Consti pation, Decrease in appetite, Diarrhea,
Nausea, Xerostomia
Neurologic: Dizziness,
Headache, Insomnia,
Somnolence
Other: Fatigue
Dermatologic: Pruritus,
Rash
Gastrointestinal: Consti pation, Drug-induced gingival hyperplasia,
Nausea, Vomiting
Hepatic: Hepatotoxicity
Musculoskeletal: Osteo malacia
Neurologic: Ataxia,
Choreoathetosis,
Coordination problem,
Dizziness,
Encephalopathy,
Headache, Insomnia,
Paresthesia, Slurred speech
Psychiatric: Confusion,
Feeling nervous
Cardiovascular: Hypert ension
Dermatologic: Sweatin g symptom
Endocrine metabolic: Weight loss
Gastrointestinal: Consti pation, Loss of appetite,
Nausea, Xerostomia
Neurologic: Asthenia,

Klonopin
Lexapro clonazepam escitalopram
Antianxiety/
Anticonvulsant/
Benzodiazepine
Antidepressant/
Serotonin
Reuptake
Inhibitor
Clonazepam is a benzodiazepine that has no definite antiseizure and antipanic mechanism of action, although it is believed to be related to its capacity to enhance GABA activity which is the major inhibitory neurotransmitter in the central nervous system. It is able to suppress the spike and wave discharges in absence seizures and decrease the frequency, duration, amplitude and spread of discharge in minor motor seizures
Escitalopram oxalate, a selective serotonin reuptake inhibitor (SSRI) and Senantiomer of racemic citalopram, enhances serotonergic activity in the central nervous system (CNS) as a result of its inhibition of serotonin (5-HT) reuptake in
CNS neurons. It possesses no or very low affinity for serotonergic (5-HT1-7), alpha- and beta-adrenergic, dopamine
(D1-5), histamine (H1-3), muscarinic (M1-5), and benzodiazepine receptors as initial, 0.25 mg
ORALLY twice a day for 3 days, then 0.5 mg twice a day maintenance, may increase dosage by
0.125 to 0.25 mg
ORALLY twice a day every 3 days to a MAX total daily dose of 1 to 4 mg (divided into 2 to 3 daily doses) initial, 10 mg/day
ORALLY as a single dose in the morning or evening maintenance, 10 mg/day ORALLY, may increase to 20 mg/day
ORALLY only after a minimum of one week
Dizziness, Dream disorder, Headache,
Insomnia, Somnolence,
Tremor
Ophthalmic: Blurred vision
Psychiatric: Feeling nervous
Reproductive: Abnorma l ejaculation, Impotence,
Orgasm disorder
Gastrointestinal: Exces sive salivation
Neurologic: Ataxia,
Dizziness, Impaired cognition, Seizure,
Aggravation,
Somnolence
Psychiatric: Depression
, Feeling nervous,
Problem behavior
Respiratory: Respirator y depression
Dermatologic: Diaphore sis
Gastrointestinal: of ejaculation,
Fatigue
Abdo minal pain, Constipation,
Diarrhea, Indigestion,
Nausea, Vomiting,
Xerostomia
Neurologic: Dizziness,
Headache, Insomnia,
Somnolence
Reproductive: Disorder
Impotence, Orgasm incapacity, Reduced libido
Other:

Neurotin
Paxil
Pristiq gabapentin paroxetine
Anticonvulsant/
Gamma
Aminobutyric
Acid well as various ion channels including Na+, K+, Cl-, and
Ca++ channels
Gabapentin is structurally related to the neurotransmitter
GABA; however, gabapentin and its metabolites do not bind to GABA(A) or GABA(B) receptors or influence the degradation or uptake of
GABA. The mechanism by which gabapentin exerts its analgesic and anticonvulsant effects is unknown
Antidepressant/
Serotonin
Reuptake
Inhibitor
Paroxetine hydrochloride is a psychotropic agent that enhances serotonergic activity in the central nervous system by selectively inhibiting the reuptake of serotonin (5hydroxy-tryptamine, 5-HT) into neurons. It interferes with the neuronal reuptake of dopamine and norepinephrine to a lesser degree. Its affinity for muscarinic, alpha(1)-, alpha(2)-
, beta-adrenergic-, dopamine(D2)-, 5HT(1)-,
5HT(2)-, and histamine(H1)receptors is weak
20 mg/day ORALLY in the morning; may increase dose by 10mg/day increments at intervals of at least 1 week desvenlafaxine Antidepressant/
Serotonin/Norep inephrine
Reuptake
Inhibitor
Desvenlafaxine is a potent, selective serotonin and norepinephrine reuptake inhibitor (SNRI) that potentiates the neurotransmitter activity in the central nervous system
(CNS). Desvenlafaxine is the major active metabolite of
50 mg ORALLY once daily
Cardiovascular: Periph eral edema
Gastrointestinal: Naus ea, Vomiting
Immunologic: Viral disease
Neurologic: Ataxia,
Dizziness, Nystagmus,
Somnolence
Psychiatric: Hostile behavior
Other: Fatigue, Fever
Cardiovascular: Palpita tions, Vasodilatation
Dermatologic: Diaphore sis
Gastrointestinal: Consti pation, Diarrhea, Loss of appetite, Nausea,
Xerostomia
Neurologic: Asthenia,
Dizziness, Headache,
Insomnia, Somnolence,
Tremor
Ophthalmic: Blurred vision
Reproductive: Abnorma l ejaculation, Impotence,
Orgasm disorder,
Reduced libido
Respiratory: Yawning
Dermatologic: Diaphore sis
Endocrine metabolic: Serum cholesterol raised,
Serum triglycerides raised
Gastrointestinal: Consti

Remeron
Tenormin
Trileptal mirtazapine atenolol oxcarbazepine
Antidepressant/
Tetracyclic
Beta-Adrenergic
Blocker,
Cardioselective/
Cardiovascular
Agent
Anticonvulsant/
Dibenzazepine
Carboxamide venlafaxine, which is also used to treat major depressive disorders
Mirtazapine is a potent antagonist at serotonin 5-HT 2 and 5-HT 3 receptors, and a moderate antagonist at muscarinic receptors.
Mirtazapine produces sedative effects due to potent histamine
H 1 receptor antagonism, and orthostatic hypotension due to moderate peripheral alpha 1adrenergic receptor antagonism
15 mg/day ORALLY at bedtime; may increase in dose every 1-2 weeks to a max dose of
45 mg/day
Atenolol is a synthetic beta(1)selective adrenoreceptor blocking agent without membrane stabilizing or intrinsic sympathomimetic activities. It inhibits beta(2)adrenoreceptors primarily found in bronchial and vascular musculature at higher doses
Systemic: The exact mechanism by which oxcarbazepine exerts its anticonvulsant effect is unknown. It is known that the initial, 50 mg ORALLY once daily; if inadequate response after 1 week, increase to 100 mg or 200 mg
ORALLY once daily initial, 300 mg ORALLY twice a day; may increase dosage by up to 600 mg/day at weekly intervals to pation, Diarrhea, Loss of appetite, Nausea,
Vomiting, Xerostomia
Neurologic: Dizziness,
Headache, Insomnia,
Somnolence
Ophthalmic: Blurred vision
Psychiatric: Anxiety
Renal: Proteinuria
Reproductive: Erectile dysfunction
Other: Fatigue,
Withdrawal sign or symptom
Endocrine metabolic: Increased appetite, Serum triglycerides raised,
Weight gain
Gastrointestinal: Consti pation, Xerostomia
Hepatic: ALT/SGPT level raised
Neurologic: Asthenia,
Dizziness, Somnolence
Psychiatric: Disturbanc e in thinking
Cardiovascular: Bradya rrhythmia, Cold extremities, Hypotension
Neurologic: Dizziness
Psychiatric: Depression
Other: Fatigue
Gastrointestinal: Abdo minal pain, Nausea,
Vomiting
Neurologic: Abnormal gait, Ataxia, Dizziness,

Valium
Vistaril
Wellbutrin diazepam hydroxyzine bupropion
Antianxiety/
Anticonvulsant/
Benzodiazepine
Antihistamine/
Piperazine/
Respiratory agent
Antianxiety/
Azaspirodecane dione pharmacological activity of oxcarbazepine occurs primarily through its 10 –monohydroxy metabolite (MHD). In vitro studies indicate an MHDinduced blockade of voltagesensitive sodium channels, resulting in stabilization of hyperexcited neuronal membranes, inhibition of repetitive neuronal discharges, and diminution of propagation of synaptic impulses
Diazepam, a benzodiazepine derivative, is an anxiolytic, agent that reduces neuronal depolarization resulting in decreased action potentials. It enhances the action of gammaamino butyric acid (GABA) by tightly binding to A-type GABA receptors, thus opening the membrane channels and allowing the entry of chloride ions
Hydroxyzine hydrochloride is a rapid-acting true ataraxic with probable action of suppressing activity in key locations of the central nervous system's subcortical area. It also exerts bronchodilating, antispasmodic, antihistaminic, analgesic and antiemetic effects
Buspirone hydrochloride is an antianxiety agent with an unknown mechanism of action.
It exhibits high affinity for serotonin (5-HT(1A)) receptors, moderate affinity for brain D(2)-
1200 mg/day
2 to 10 mg ORALLY 2 to 4 times a day depending on symptom severity
Anxiety: 50 to 100 mg
ORALLY 4 times daily
Anxiety: 50 to 100 mg
IM immediately, then every 4 to 6 hr as needed
Anxiety: 5 mg ORALLY
2 to 3 times a day OR
7.5 mg ORALLY twice a day; may increase the dosage by 5 mg/day every 2 to 3 days as
Headache, Nystagmus,
Somnolence, Tremor
Ophthalmic: Abnormal vision, Diplopia
Other: Fatigue
Cardiovascular: Hypote nsion
Dermatologic: Rash
Gastrointestinal: Diarrh ea
Musculoskeletal: Muscl e weakness
Neurologic: Ataxia,
Incoordination,
Somnolence
Psychiatric: Euphoria
Respiratory: Respirator y depression
Other: Fatigue
Gastrointestinal: tomia
Neurologic:
Somnolence
Xeros
Headache,
Gastrointestinal: Naus ea
Neurologic: Asthenia,
Confusion, Dizziness,
Excitement, Headache,
Numbness

Wellbutrin XL
Xanax bupropion alprazolam
Antianxiety/
Azaspirodecane dione
Antianxiety/
Benzodiazepine dopamine receptors and no significant affinity for benzodiazepine receptors. It has no effect on GABA binding
Buspirone hydrochloride is an antianxiety agent with an unknown mechanism of action.
It exhibits high affinity for serotonin (5-HT(1A)) receptors, moderate affinity for brain D(2)dopamine receptors and no significant affinity for benzodiazepine receptors. It has no effect on GABA binding
Alprazolam, a CNS drug from the 1,4 benzodiazepine class, possesses an unknown mechanism of action. It presumably exerts its effects by binding to various stereospecific receptors in the CNS.
Alprazolam has also been reported to exhibit antidepressant properties, which are not characteristic of conventional benzodiazepine derivatives needed (usual dose 20 to 30 mg/day (2 to 3 divided doses), MAX dose 60 mg/day)
Anxiety: 5 mg ORALLY
2 to 3 times a day OR
7.5 mg ORALLY twice a day; may increase the dosage by 5 mg/day every 2 to 3 days as needed (usual dose 20 to 30 mg/day (2 to 3 divided doses), MAX dose 60 mg/day)
immediate-release or orally disintegrating tablet, 0.25 to 0.5 mg
ORALLY 3 times a day, may increase every 3 to
4 days if necessary;
MAX daily dose, 4 mg in divided doses
Ophthalmic: Blurred vision
Psychiatric: Feeling angry, Feeling nervous,
Hostile behavior
Gastrointestinal: Naus ea
Neurologic: Asthenia,
Confusion, Dizziness,
Excitement, Headache,
Numbness
Ophthalmic: Blurred vision
Psychiatric: Feeling angry, Feeling nervous,
Hostile behavior
Endocrine metabolic: Decrease in appetite, Increased appetite, Weight increased
Gastrointestinal: Consti pation, Reduced salivation, Xerostomia
Neurologic: Cognitive disorder, Confusion,
Dysarthria,
Incoordination,
Lightheadedness,
Memory impairment,
Sedated, Somnolence
Psychiatric: Irritability
Reproductive: Reduced libido
Other: Fatigue