Drugs are useful statistically significant but modest improvment
effect size = 1 is strong
antibiotics have a value of 1
societal impact of mental disorders depression causes largest impact of mental disorders followed by anxiety and schizophrenia
What is anxiety it is a psychological and physiological state responding to percieved threats
types of anxiety
- gad
- social anxiety disorder
- panic disorder physiological cause and clinical presentation
psychological/emotional symptoms anxiety fear nervousness worry
physical symptoms palpitaions shortness of breath dizziness msucle tension
nonpharmocological treatments for anxiety
CBT Internet based CBT ACT Mindfulness- based stress reduction exercise
pharmalogical treatemts for anxiety
firstline
- SSRIs - escitalopram
- SNRIs - venlafaxine
we dont really know how this works in the brain the locus ceralius is the main noradrenaline releaser and has inhibitory a2 receptors on the axon terminal. a NA reuptake inhibitor means higher levels in the synapse and higher inhibitory feedback
probably does it through serotonin mainly though
second line
- benzos (diazepam (valium))
good short term bad long term use for 5-14 days cold turkey can result is seizure and death
positive PAM for GABAA this means that more Cl- are let in moderate potential for abuse
high therapeutic index interacts with other depressants drowsiness decreased alertness and ataxia
you can have tolerance without dependancee
tolerance is associated with a decrease in gabaa recptores in certain areas areas
dependance is withdrawal symptom on stopping taking the drug. it will be general CNS elevation
slow withdrawal is needed or severe adverse reactions can occur
- anticolvulsants
- betablockers propanolol is good for performance anxiety - reduces tremor and good for shooting and surgery
nonselective ß1 and ß2 antagonist low effect in normal people at rest. if you constantly have adrenaline in fight or flight (anxiety) you will see reduced adrenaline activity
- tricyclics
Insomnia
insomnia has many causes
psychological
- anxiety depression, dementia, psychosis physical
drugs
- amphetamines and caddine environment technology and life distractors
benzos and z drugs
gaba a PAM