Dr.

Shazia Habib

Presented by: (Group 1)

Khadija Khan (230615)
Laiba Hanif (230629)
Faizan Nawaz (230634)

Department of Applied Psychology

Govt. College University Faisalabad
 Anxiety Disorders

Anxiety disorders involve excessive worry, fear, or

nervousness.

They can significantly impact daily life and

functioning.

Examples include Generalized Anxiety Disorder

(GAD), Panic Disorder, Social Anxiety Disorder
(SAD), and specific phobias
 Obsessive
Compulsive Disorder

➢ OCD is characterized by:

Obsessions: Recurrent, unwanted thoughts,

images, or urges.

Compulsions: Repetitive behaviors or mental

acts performed to reduce anxiety or prevent
perceived harm.

➢ OCD can lead to significant distress and

impairment in various areas of life.
 Treatment

Psychopharmacological
Usually a type of antidepressant medicine that can help
by altering the balance of chemicals in your brain

Psychotherapeutic
Cognitive-behavioral therapy (CBT), Exposure therapy,
Mindfulness-based therapy
Importance of Psychopharmacology

• Pharmacotherapy refers to the use of medications

in treatment.

• It plays a crucial role in managing symptoms of

anxiety disorders and OCD.

• Provides relief, especially for moderate to severe

cases.
 Types of Medicines Used

Benzodiazpines SSRIs

SNRIs TCAs
 Mechanism of Action

Medications target Alleviate anxiety

neurotransmitters in symptoms
the brain

Reduce the frequency

and intensity of
Regulate mood
obsessive thoughts and
compulsive behaviors
Combined Approach
• Pharmacotherapy should be used in
conjunction with:

• Therapy (e.g., cognitive-behavioral

therapy)

• Lifestyle changes

• Other non-pharmacological
interventions

• Combined approach yields the most

effective treatment outcomes.
▪ Anxiolytics are medications
that can
treat anxiety symptoms.

▪ “Anxiolytic” combines two root

words from ancient Greek,
“anxio-” meaning “anxiety” and
Anxiolytics
“-lytic,” meaning “to loosen.”

▪ These medications “loosen”

anxiety’s hold on us.
 Benzodiazepines

➢ Widely used class of anxiolytic medications.

➢ Effective for short-term management of anxiety

symptoms.

Mechanism of Action

➢ Enhance the activity of gamma-aminobutyric acid

(GABA), a neurotransmitter that inhibits brain
activity.

➢ Result in calming and sedative effects.

➢ Modulate the brain's response to anxiety.

 Common Benzodiazepines

➢ Xanax (alprazolam)

➢ Valium (diazepam)

➢ Ativan (lorazepam)

➢ Klonopin (clonazepam)

➢ Others: Librium, Tranxene, Restoril

 Xanax (alprazolam)

Effect: It produces calming effects by enhancing the activity

of GABA receptors in the brain, leading to decreased anxiety
and relaxation.

Dosage: Typical 0.25-0.5 mg taken orally three times daily.

The dosage may be gradually increased as needed, with the
maximum daily dose typically not exceeding 4 mg. For panic
disorder, initial doses may be higher, around 0.5-1 mg taken
orally two to three times daily
Side Effects
 Valium (diazepam)

Effect: Used for various conditions, including anxiety disorders,

muscle spasms, and alcohol withdrawal. It results in anxiolytic,
muscle relaxant, and sedative effects.

Dosage: For anxiety, the usual starting dose is 2-10 mg taken

orally two to four times daily. Not exceeding 30 mg per day. For
muscle spasms, lower doses may be used initially.

Side Effects of Valium

▪ Drowsiness
▪ Fatigue
▪ Muscle weakness
▪ Unsteady gait
▪ Cognitive issues
 Ativan (lorazepam)

Effect:

For the short-term relief of anxiety symptoms and panic attacks.

Approved for treating seizures, chemotherapy-related nausea and

vomiting, anxiety, pre-anesthesia for surgery and procedures, and
phobias.

Dosage:

1-2 mg taken orally two to three times daily. Maximum daily

dose typically not exceeding 10 mg. For panic disorder, initial
doses may be higher, around 2-3 mg taken orally two to three
times daily.
 Klonopin (clonazepam)
Effect:

Klonopin is used for the treatment of panic disorder, certain

types of seizures, agitation and sometimes for social anxiety
disorder.

Dosage:

For adults with panic disorder is 0.25 mg taken orally twice

daily. The dose may be gradually increased every 3 days until
panic disorder is controlled, with the maximum recommended
dose being 4 mg per day. For seizures, the starting dose is
usually higher, and adjustments are made based on response.
 Benefits of Benzodiazepines

➢ Rapid onset of action.

➢ Effective for acute anxiety episodes or panic

attacks.

➢ Generally well-tolerated when used short-term and

at low doses.

➢ Can be helpful for specific phobias and social

anxiety disorder.
 Limitations of Benzodiazepines

➢ Risk of tolerance and dependence with long-term use.

➢ Potential for withdrawal symptoms upon discontinuation.

➢ Sedation, dizziness, and impaired coordination are common side effects.

➢ Not recommended for long-term use or as first-line treatment for chronic

anxiety disorders.

Risk of Abuse and Addiction

➢ Benzodiazepines can be habit-forming.

➢ Misuse and abuse may lead to addiction.

➢ Caution should be exercised, especially in individuals with a history of

substance abuse.
 Buspirone

It is sold under the brand name Buspar, among others,

is an anxiolytic, a medication primarily used to
treat anxiety disorders, particularly generalized anxiety
disorder. It is a serotonin 5-HT1A receptor agonist,
increasing action at serotonin receptors in the brain. It
is taken orally, and takes two to six weeks to be fully
effective
 Mechanism of Action

➢ Buspirone is an anxiolytic medication.

➢ It acts as a serotonin 5-HT1A receptor partial agonist.

➢ Buspirone's anxiolytic action is believed to result from its

modulation of serotonin activity in the brain.

Efficacy

➢ Primarily for the treatment of generalized anxiety disorder (GAD)

➢ It may take several weeks of regular use to achieve full therapeutic

effects.

➢ Studies have shown that buspirone is effective in reducing anxiety

symptoms in patients with GAD.
 Side Effects

Common side effects of buspirone may include:

➢ Dizziness

➢ Nausea

➢ Headache

➢ Nervousness

➢ Lightheadedness
 Comparison with Benzodiazepines

➢ Unlike benzodiazepines, buspirone does not cause

sedation or impair cognitive function.

➢ It does not carry the risk of tolerance, dependence, or

withdrawal symptoms associated with benzodiazepines.

➢ Buspirone may be preferred for individuals who have a

history of substance abuse or concerns about the
potential for addiction.

➢ However, it may not provide immediate relief for acute

anxiety symptoms and is generally less potent than
benzodiazepines.
 Hydroxyzine

Sold under the brand names Atarax and Vistaril among others, is
an antihistamine medication. It is used either by mouth or injection
into a muscle.

Mechanism of Action

➢ Hydroxyzine acts as an antagonist at histamine H1 receptors in

the brain.

➢ It also exhibits anxiolytic effects through its sedating properties

and modulation of serotonin and noradrenaline activity.
 Use as an Adjunct or Alternative

Hydroxyzine is an antihistamine with anxiolytic properties.

It is commonly used as an adjunct or alternative treatment

for anxiety disorders, particularly when other medications
are ineffective or not well-tolerated.

Hydroxyzine may be prescribed off-label for anxiety,

insomnia, and pruritus (itching).
 Side Effects

➢ Common side effects of hydroxyzine may include:

Sedation
Dizziness
Dry mouth
Blurred vision
Constipation
Urinary retention

➢ Less common side effects may include confusion, tremors,

and hypotension.

➢ Hydroxyzine may cause significant sedation, especially at

higher doses, which can impair cognitive function and
motor skills.
 Hydroxyzine Warnings

➢ Pregnant women

➢ Nursing mothers

➢ Drivers and Heavy machine operators

➢ Older adult

➢ Blurry vision (glaucoma)

➢ Lung disease (asthma or COPD)

➢ Heart diseases

➢ Alcoholics and narcotics

Antidepressants
for Anxiety and
OCD
Laiba Hanif (624)
Group 1
 Table of contents
01 02 03

SSRIs Frist-line treatment Mechanism of action

and therapeutic effects

04 05 06

SNRIs TCAs & MAOIs Side effect profiles

 01.
Introduction
 Introduction

Antidepressants are pivotal in managing anxiety

disorders and obsessive-compulsive disorder (OCD),
conditions that significantly impact millions globally.
In this presentation, we'll explore how medications
like SSRIs, SNRIs, TCAs, and MAOIs work to alleviate
symptoms, providing crucial relief and improving the
quality of life for those affected.
 SSRIs

Usage
First-line treatment for various anxiety disorders (e.g., generalized anxiety
disorder, social anxiety disorder) and OCD.

Example
- Prozac (fluoxetine): Introduced in 1987, widely prescribed for anxiety and
depression.
- Zoloft (sertraline): Approved for OCD treatment in 1999, also used for
panic disorder.
- Lexapro (escitalopram): Known for high tolerability, often used in anxiety
disorders.
 SSRIs

Mechanism of Therapeutic
Action effect
Inhibit the reuptake of Reduce anxiety symptoms,
serotonin, enhancing its obsessive thoughts, and
availability in the synaptic compulsive behaviors.
cleft.

Statistics
SSRIs are prescribed to
millions of individuals
globally, with Prozac being
one of the most commonly
prescribed antidepressants.
 SNRIs

Usage
Employed in treatment-resistant anxiety cases or when depression coexists
with anxiety disorders.

Example
- Effexor (venlafaxine): Dual-action SNRI used for various anxiety disorders
and depression.
- Cymbalta (duloxetine): Indicated for generalized anxiety disorder and
chronic pain management.
 SNRIs

Mechanism of Therapeutic
Action effect
Inhibit the reuptake of both Improve mood, reduce
serotonin and norepinephrine, anxiety symptoms, and
modulating mood and anxiety alleviate certain types of
response. chronic pain.

Statistics
SNRIs are increasingly
prescribed due to their
efficacy in managing both
anxiety and depressive
symptoms.
 TCAs & MAOIs

Usage
Reserved for refractory cases where SSRIs and SNRIs are ineffective or not
tolerated.

Example
- TCAs like amitriptyline and nortriptyline are used for severe anxiety and
OCD.
- MAOIs such as phenelzine and tranylcypromine are considered when other
options fail.
 TCAs & MAOIs

Mechanism of Therapeutic
Action effect
TCAs block serotonin and Effective in treating severe
norepinephrine reuptake, symptoms but have a
while MAOIs inhibit higher risk of side effects
monoamine oxidase enzyme and interactions.
activity.

Statistics
TCAs and MAOIs usage has
declined due to the
development of safer and
more tolerable alternatives
like SSRIs and SNRIs.
 Side Effects

SSRIs SNRIs TCAs & MAOIs

• Gastrointestinal • Nausea, vomiting, or • Dry mouth, blurred
disturbances digestive issues vision, or constipation

• Headache, dizziness, or • Drowsiness or fatigue • Drowsiness or sedation

lightheadedness
• Dry mouth or changes • Weight gain
• Changes in sleep patterns in taste perception
• Urinary retention
• Sexual dysfunction • Increased sweating
• Tremors or muscle
• Weight changes • Sexual dysfunction stiffness
Other
Medications
● Anxiety disorders and Obsessive-Compulsive
Disorder (OCD) are prevalent mental health
conditions affecting millions worldwide. While
selective serotonin reuptake inhibitors (SSRIs)
and serotonin-norepinephrine reuptake inhibitors
(SNRIs) are commonly prescribed, several other
medications show promise in managing
symptoms.
● We will discuss two such medications that are
used to treat such patients: beta-blockers and
pregabalin/gabapentin.
 Beta-blockers (e.g., propranolol)
● Function: Primarily used to treat hypertension and cardiac conditions, beta-
blockers like propranolol can also alleviate symptoms of performance anxiety and
specific phobias.
● Mechanism of Action: Blocks the effects of adrenaline, reducing the physical
symptoms of anxiety such as rapid heartbeat, trembling, and sweating.
 Continue..
Clinical Applications
● Performance Anxiety: Beta-blockers are frequently employed by individuals facing
situations characterized by heightened performance anxiety, such as public
speaking engagements, musical performances, or athletic competitions.
● Specific Phobias: In scenarios where exposure to specific triggers induces
overwhelming anxiety responses (e.g., fear of flying, heights, or enclosed spaces),
beta-blockers can help manage physiological symptoms, enabling individuals to
navigate such situations with greater ease.
 Continue…
● Effectiveness: Studies indicate beta-blockers'
efficacy in curbing physical manifestations of
anxiety, though they do not address psychological
aspects.
● Efficacy and Considerations: Research suggests
beta-blockers' efficacy in attenuating physical
symptoms of anxiety. However, it's crucial to note
that they do not address the underlying
psychological components of anxiety disorders.
Additionally, individual responses to beta-blockers
may vary, and cautious dosing is essential,
particularly in individuals with pre-existing cardiac
conditions or asthma.
 Pregabalin and Gabapentin:
● Function: Originally developed to treat epilepsy, pregabalin and gabapentin are
now prescribed as adjunctive treatments for certain anxiety disorders.
● Mechanism of Action: Both medications modulate the release of
neurotransmitters, particularly gamma-aminobutyric acid (GABA), which helps calm
overactive nerve firings associated with anxiety.
THANK YOU