Thursday – Mar 1 Exam I is Tuesday, Mar 6 Benzodiazepines and Other Medications for Anxiety. Benzodiazepines (BZD) defined by the presence of a benzene ring fused with a 7 membered diazepine ring 1 st one introduced in 1960 – Librium (chlordiazepoxide)
Exam I is Tuesday, Mar 6
Benzodiazepines and Other Medications for Anxiety
A particular BZD is chosen for one condition vs another mostly based on half-life and rapidity of effect.
- short half life – quick onset of action
anticonvulsant; muscle relaxant; sleep aid; panic disorder
- long half life – days to work (blood protein binding)
chronic treatments for anxiety; seizure disorders; some muscular disorders
Sedation and interference with new memory formation (anterograde amnesia)
Tolerance for these effects within a few days for oral dosing regimens.
BZDs used as sleeping pills are usually indicated for short term use – no more than 1-2 months. The particular BZDs show less tolerance.
Dalmane (flurazepam) – common sleep aid
Ambien – not a BZD – Zolpidem tartrate; does enhance GABA action
4. Serotonergic response Disorder
mCPP is a serotonergic receptor agonist that has the ability to induce anxiety and panic in some normal individuals. Among panic disordered, reaction occurs at a lower threshold and among high percentage of people.
Similar for fenfluramine, a drug that causes release of serotonin – lower threshold for induction of panic in panic-disordered than normals.
Too much makes anyone anxious – panic at lower threshold in panic-disordered.
Caffeine also enhances taste sensitivity – occurs at lower dose in panic disordered than normals. So not just an anxiety category effect
In anxious strains of rats – decreased number of GABAA – BZD receptors
Preliminary human evidence for less GABA activity in humans with anxiety disorders.
Treatments for Panic Disorder Disorder
1. fast-acting, short half-life BZDS
2. Some antidepressants – older tricyclics
3. newer serotonin agonist, BuSpar
2. Phobic Disorder Disorder
Phobia – extreme fear of a specific stimulus or situation without rational basis
Agoraphobia – fear of being alone in a public place or somewhere where help may not be available.
Sufferers recognize that degree of fear is unwarranted but cannot control it.
Many people with Panic Disorder have agoraphobia as well.
Treatments: Paxil (an SSRI); beta-blockers (propanolol = Inderal) – suppresses sympathetic reaction during fear
3. Obsessive-Compulsive Disorder Disorder
Obsessions – intrusive, persistent ideas or worries
(Did I lock the door? Am I clean? Will I get hurt?)
Compulsions – repetitive behaviors performed in a stereotyped manner according to rigid rules.
Lock checking; hand washing; cleaning; specific route that must be taken to avoid danger (step only on certain blocks in sidewalk)
Jack Nicholson in “As Good As It Gets”; Mr. Monk
Treatments – selective serotonin reuptake inhibitors