Background
Anxiety is covered moreso in its note but this is a refresher.
Anxiety is a psychological and physiological state responding to percieved threats which interrupts normal activities. Worry is normal. Pathological levels of worry is called an anxiety disorder.
Presentation of Anxiety disorders
The presentation of anxiety is usually split into 2 parts, psychological and physical.
Psychological/emotional symptoms
- Anxiety
- Fear
- nervousness
- worry
Physical symptoms (all very sympathetic)
- Palpitations
- Shortness of breath
- Dizziness
- Muscle tension
Types of anxiety disorder
- generalised anxiety disorder
- Social anxiety disorder
- Panic disorder
- Phobias, PTSD, OCD, etc
Treatments
Non-pharmacological treatments of anxiety
Non-pharmacological treatments of anxiety are numberous and actually highly efficacious.
Some include:
- Cognitive behavioural therapy (CBT)
- Internet based Cognitive Behavioural Therapy
- Acceptance and Commitment therapy (ACT)
- Mindfulness-based stress reduction
- Exercise
Pharmacological treatments of anxiety
First line
The first line pharmacological treatment of anxiety are SSRIs (like escitalopram) and SNRIs (Like venlafaxine).
It is theorised that SNRIs have additional benefit from increasing noradrenaline signalling in the locus coeruleus, and in this adrenergic α2 activation levels release fo systemic noradrenaline.
This leads to reduced central sympathetic symptoms and thus, lessened physical symptoms of anxiety
Second line
The second line treatments for anxiety include Benzodiazipines. anticonvulsants like gabapentin, beta blockers like propanolol, and tricyclic antidepressants.
all of these either increase inhibition (and depress the nervous system) or calm down the sympathetic nervous system to reduce physical symptoms of anxiety.
Propanolol is especially good at reducing performance anxiety, redicing racing heart and tremor and such.
Insomnia & hypnotics
Insomnia is treated by lifestyle changes, such as increasing sleep hygiene. this includes
- regular bedtimes
- trying not exercise 2-3 hours before bed
- avoid caffiene and nicotine
- avoid drinking
- low room temp
- avoid screens
- dont lie in bed awake
Drugs for the treatment of insomnia are called Z drugs (such as zopiclone) and are positive allosteric modulators for GABAA receptors. They have a short duration and and should be used for MAX 5-14 day consecutively. They have reasonable dependance potential and should be used with good sleep hygiene as a booster to get to a sleeping goal.
General other uses for gaba drugs
Gaba drugs can be used for general anaethesia (sevoflurane, propofol), muscle spasms (benzos and baclofen), and depression (benzos for acute treatment after trauma)