WK 8 Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Potential Impacts of Pharmacotherapeutics Used in the Treatment of GAD

Various classes of medications have been proven to have efficacy in managing and treating Generalized Anxiety Disorder (GAD). These include selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs), benzodiazepines, azapirones, anti-adrenergic medications, melatonin analogs, and second-generation antipsychotics (SGAs) (Strawn et al., 2018). SSRIs and SNRIs can be administered as first-line psychopharmacologic treatment, while benzodiazepines and SGAs, among other classes, can be used as second-line pharmacotherapies in adults. As all potential pharmacotherapeutic options have shown to have a higher level of efficacy in GAD treatment, it is important to evaluate the potential drug effects of the distinct classes.

Most medications in the SSRIs and SNRIs classes are well-tolerated (Wang et al., 2018). However, SSRIs and SNRIs such as clozapine, olanzapine, risperidone, sertindole, and aripiprazole have been linked to cardiovascular effects, including orthostatic hypotension (Pacher & Kecskemeti, 2005). Other serious effects include sexual dysfunction (Schweitzer et al., 2009) and hepatoxicity (Wang et al., 2018). Second-generation antipsychotic (SGA) use is related to metabolic side effects. SGAs such as olanzapine and risperidone may lead to adverse metabolic side effects, including weight gain and a higher risk of diabetes mellitus (Stogios et al., 2021).

Moreover, benzodiazepines, including remimazolam, 3-hydroxyphenazapam, adinazolam, clonazolam, and deschloroetizolam are linked to memory problems, suicidality, delirium, and increased risk of the patient becoming dependent on the medication after prolonged use (Cornett et al., 2018). In extreme cases, patients who prolong the use of anti-adrenergic medications such as clonidine and guanfacine experience bradycardia, hypotension, hyperglycemia, and hypodynamic shock. All classes of antidepressants used in the treatment of GAD have common side effects, including nausea, tiredness, dizziness, confusion, drowsiness, loss of appetite, and increased anxiety.

References

Cornett, E. M., Novitch, M. B., Brunk, A. J., Davidson, K. S., Menard, B. L., Urman, R. D., & Kaye, A. D. (2018). New benzodiazepines for sedation. Best Practice & Research Clinical Anaesthesiology, 32(2), 149–164. https://doi.org/10.1016/J.BPA.2018.06.007

Pacher, P., & Kecskemeti, V. (2005). Cardiovascular Side Effects of New Antidepressants and Antipsychotics: New Drugs, old Concerns? Current Pharmaceutical Design, 10(20), 2463–2475. https://doi.org/10.2174/1381612043383872