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Response1

Hello everyone! I think Generalized Anxiety disorder is best treated with SSRI’s since they have the least side-effects compared to SNRI’s and don’t have the risk for seizures when abruptly discontinued like Benzodiazepines. The SSRI’s are great for long-term treatment of multiple forms of anxiety and treat depression too. Paroxetine and Escitalopram are the main two SSRI’s prescribed for anxiety, but do take roughly 4 weeks to reach therapeutic levels and just as long to remove the drug from circulation. The SSRI’s are taken orally, absorbed through the GI tract. Excreted through the kidneys and metabolized by the liver by the CYP2D6 enzyme. The SSRI’s block reuptake of serotonin in the synaptic cleft of 5-HT which increases the amount of Serotonin available which is believed to be deficient in patients with depression and anxiety.  (Overview – Selective serotonin reuptake inhibitors (SSRIs), 2021). SSRI’s and SNRI’s are generally more tolerable than benzodiazepines, buspar, SGA’s and antiepileptic medications are due to their side-effects. They also may require more monitoring and benzodiazepines have higher rates of abuse. TCA’s also have shown great efficacy in its treatment of GAD, but also requires monitoring to tolerability amongst patients. 2APA refernce

Response 2.

According to the National Institute of Mental Health [NIMH], occasional anxiety is part of life. However, when one has continuous and uncontrolled worrying for six months on most days, this is termed a Generalized anxiety disorder (GAD) (2022). Symptoms of GAD include feeling restless, wound-up, or on-edge, being easily fatigued, having difficulty concentrating; mind going blank, being irritable, having muscle tension, difficulty controlling feelings of worry, having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep (NIMH, 2022). Patients with GAD may also have an underlying psychiatric disorder, usually depression (Rosenthal & Burchum, 2021). This discussion will compare treatment options for a patient diagnosed with GAD and the factors that can influence the pharmacokinetic and pharmacodynamic of using these anxiety drugs on the patient. Serotonergic reuptake inhibitors (SRIs) that are both selective serotonin reuptake inhibitors [SSRIs] and serotonin-norepinephrine reuptake inhibitors [SNRIs] and benzodiazepines are considered the first-line treatment of GAD (Rosenthal & Burchum, 2021). SSRIs selectively block the neuronal reuptake of serotonin, 5-hydroxytryptamine [5-HT]. An increase in 5-HT causes an increase in postsynaptic 5-HT receptors, and this intensifies monoamine effects (Rosenthal & Burchum, 2021). SNRIs block norepinephrine and 5-HT reuptake, and their pharmacological process is similar to that of SSRIs. SRIs drugs for the treatment of GAD include Lexapro, Paxil, Buspar, Duloxetine, Effexor, and Zoloft. Benzodiazepines drugs include Diazepam and alprazolam (Rosenthal & Burchum, 2021). Initial therapeutic response for SRIs may take a week, and optimal response may take about four weeks. Onset treatment with benzodiazepines is immediate,  but the use of SRIs is the first choice for long-term treatment of GAD due to decreased dependency and a better job of decreasing cognitive and psychic symptoms associated with anxiety (Rosenthal & Burchum, 2021). Both SRIs and benzodiazepines are metabolized in the liver, so caution when prescribing to patients with suspected liver dysfunctions. A patient with a history of ETOH who works in a factory that operates heavy machinery has never taken any psychotropic before, presents with anxiety symptoms, and was diagnosed with GAD after assessments. Treatment options will be based on currently approved FDA treatment for GAD. In addition, the provider has to consider the patient’s social and work life to prescribe the most appropriate drug, dosage, frequency, and time. Factors such as excessive alcohol use, illicit drug abuse, and dependency can influence the use of medications to treat GAD, especially benzodiazepine, which causes adverse effects resulting from depressant actions in the central nervous system (CNS).

For the patient with ETOH and operates heavy machinery for work diagnosed with GAD, will prescribe Zoloft 50mg by mouth daily for four weeks and reassess for improvement in patient symptoms. Though benzodiazepine might work faster to reduce symptoms, it will hold off due to the patient’s history of ETOH and the line of work because long-term use can cause physical dependence and abuse. Interaction with alcohol can increase depressant actions in the CNS. Benzodiazepine can be used as needed for acute anxiety attacks ( Garakani et al., 2020). 2APA refrences