Pathophysiology of Anxiety Disorder

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It can be anticipatory before a threat, persist after a threat has passed, or occur without an identifiable threat. Anxiety is often accompanied by physical changes and behaviors similar to those caused by fear.

Causes:

Some general medical disorders can directly cause anxiety; they include the following:

  • Hyperthyroidism

  • Pheochromocytoma(a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache)

  • Hyperadrenocorticism (Cushing’s syndrome: a glandular disorder caused by excessive cortisol.)

  • Heart failure

  • Arrhythmias

  • Asthma

  • COPD

Other causes include use of drugs; effects of corticosteroids, cocaine, amphetamines, and even caffeine can mimic anxiety disorders. Withdrawal from alcohol, sedatives, and some illicit drugs can also cause anxiety.

Symptoms and Signs:

  • Anxiety can arise suddenly, as in panic, or gradually over many minutes, hours, or even days. Anxiety may last from a few seconds to years; longer duration is more characteristic of anxiety disorders. Anxiety ranges from barely noticeable qualms to complete panic. The ability to tolerate a given level of anxiety varies from person to person.

  • Feelings of uneasiness or worries

  • Trouble concentrating

  • Feeling tense and jumpy

  • Anticipating the worst

  • Irritability

  • Restlessness

  • Watching for signs of danger

  • Feeling like your mind’s gone blank

Side effects of SSRIs may include, among others:

  • Nausea

  • Nervousness, agitation or restlessness

  • Dizziness

  • Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)

  • Drowsiness

  • Insomnia

  • Weight gain or loss

  • Headache

  • Dry mouth

  • Vomiting

  • Diarrhea

Prescription contains:

  • Benzodiazepines

    • Alprazolam

    • Clonazepam

    • Diazepam

    • Lorazepam

    • Triazolam

  • Chlordiazepoxide, Clorazepate, Diazepam, Lorazepam, and Midazolam are used for anxiety disorders

SSRIs (Selective serotonin reuptake inhibitors)

  • Citalopram

  • Escitalopram

  • Fluoxetine

  • Paroxetine

  • Sertraline

Drugs and Dose:

Benzodiazepines differ in how quickly they work, and for what they are most commonly used.

  • Diazepam  and Clorazepate  have fast onsets of action,

  • Oxazepam  has a slow onset, and

  • Lorazepam , Alprazolam, and Clonazepam  have intermediate onset

  • Paroxetine CR is an SSRI that provides controlled release of the medication throughout the day or for a week at a time with a single dose.

  • Paxil CR is an SSRI that provides controlled release of the medication throughout the day or for a week at a time with a single dose

Safety concerns:

SSRIs are relatively safe. However, here are some examples of safety issues to be considered;

  • Antidepressants and pregnancy. Some antidepressants may harm child if taken during pregnancy or while breast-feeding. Paroxetine  in particular appears to increase the risk of birth defects, including heart and lung problems. If taking an antidepressant and are considering to getting pregnant, talk to doctor or mental health provider about the possible dangers. Don’t stop taking  medication without contacting doctor first.

  • Drug interactions. When taking an antidepressant, be sure to tell doctor about any other medications or dietary supplements being taken. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal remedies.

  • Abnormal bleeding. Use of some pain relievers, such as aspirin, ibuprofen  or naproxen sodium , or anticoagulants, such as warfarin, may increase the risk of bleeding when combined with SSRIs. Know  about the risks of using these medications in combination.

  • Serotonin syndrome. Rarely, an SSRI can cause dangerously high levels of serotonin. This is known as serotonin syndrome. It occurs when two medications that raise serotonin are combined. These include other antidepressants, certain pain or headache medications. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate.If noticed to have any of these signs or symptoms counsel the patients carefully.

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