NURS 6521 Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

NURS 6521 Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder is a chronic condition characterized by uncontrollable worrying, and of all anxiety disorders, GAD is the most least likely to remit (Rosenthal & Burchum, 2021). Depression is usually associated with GAD. According to Rosenthal & Burchum (2021), the hallmark of GAD is unrealistic or excessive anxiety about several events or activities. The FDA approved first-line medication choices include SSRI’s, SNRI’s and buspirone. The approved second line of medication is benzodiazepine. Antidepressants have a delay effect which can take several weeks to take effect, while benzodiazepine’s onset is rapid. The four main first-line medications include SSRI – Paroxetine (Paxil) & Escitalopram (Lexapro), SNRI – Venlafaxine (Effexor XR) & Duloxetine (Cymbalta).

Pharmacodynamics for SSRI’s according to Rosenthal & Burchum (2021), is by selectively blocking neuronal reuptake of serotonin 5-HT, a monoamine neurotransmitter. The reuptake concentration of 5-HT in the synapse increases, which activates the postsynaptic 5-ht receptors, this mechanism which is consistent with the theory that depression stems from a deficiency in monoamine-mediated transmission (Rosenthal & Burchum, 2021).

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Pharmacokinetics for SSRI’s, oral medication is well absorbed, even in the presence of food. They are metabolized by the liver primarily by CYP2D6, then followed by excretion in the urine (Rosenthal & Burchum, 2021). SSRI’s are known to cause sexual dysfunction including impotence and delayed orgasm, delayed ejaculation and decreased sexual interest. Weight gain is also associated with SSRI’s possibly due to the decreased sensitivity of 5-HT receptors that regulate appetite (Rosenthal & Burchum, 2021). MAOI’s are to be avoided when taking SSRI’s due to the risk of serotonin syndrome, which can be life threatening if left untreated.