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

Pharmacodynamics for SNRI’s block the neuronal reuptake of serotonin and norepinephrine, with minimal effects of

other transmitters or receptors (Rosenthal & Burchum, 2021). The drug produces a powerful blockade of NE and 5HT reuptake and weak blockade of dopamine reuptake. There is evidence that SSRI’s are tolerated and considered safer to take.

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Pharmacokinetics for SNRI’s, orally they are well absorbed. The liver converts the medication to desvenlafaxine and active metabolite. The half-life is 5 hours for the parent drug and 11 hours for the active metabolite (Rosenthal & Burchum, 2021). SNRI’s are also known to cause sexual dysfunction. In addition, monitoring blood pressure is needed due to dose related diastolic hypertension. The patient will need to have their sodium levels monitored especially if taking a diuretic which will increase the chance of hyponatremia. As with SSRI’s MAOI’s will need to be avoided due to the risk of serotonin syndrome.

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In comparison according to Jakuboyski et al, (2018), higher doses of SSRIs within the therapeutic range are associated with greater treatment benefit, whereas higher doses of SNRIs are not.

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According to Ruhe et al, (2019), Because the prevalence of antidepressant withdrawal symptoms is unknown and not all patients require dose reductions to discontinue antidepressants, three risk-factors that are consistently reported in the literature to indicate an increased risk of antidepressant withdrawal symptoms: (1) dosing above the minimal effective dose to reach efficacy, (2) antidepressant withdrawal symptoms when a dose was missed or during strategic treatment interruption, and (3) earlier failed attempts to discontinue the SSRI or SNRI.

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Benzodiazepine, though the second line in treatment for anxiety due to the risk of dependence, is the first line for an acute anxiety attack. According to Rosenthal & Burchum (2021), benefits derive from enhancing responses to GABA, an inhibitory neurotransmitter. Benzodiazepines should be avoided in patients with a known history of drug abuse.  

References

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Jakubovski, E., Johnson, J. A., Nasir, M., Müller-Vahl, K., & Bloch, M. H. (2018). Systematic Review and meta-analysis: Dose-response curve of ssris and Snris in anxiety disorders. Depression and Anxiety, 36(3), 198–212. https://doi.org/10.1002/da.22854

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Rosenthal, L. D., & Burchum, J. R. (2021). Lehnes pharmacotherapeutics for advanced practice nurses and physician assistants. St. Louis, MO: Elsevier.