4 Must-Know Facts About Anxiety

In honor of National Anxiety and Depression Awareness Week, pharmacists should take the time to ensure patients with anxiety are aware of the basic facts about their condition.

Social stigma may cause some patients to hesitate in discussing their anxiety, which contributes to the fact that anxiety disorders are underdiagnosed and undertreated despite a lifetime prevalence of 16.6%. This makes pharmacist counseling even more important.

Here are some must-know facts about anxiety:

1. There are several different types of anxiety disorders.

Anxiety disorders come in different shapes and sizes.

There are 4 major types of anxiety disorders:

Generalized Anxiety Disorder (GAD)

Patients with GAD tend to excessively worry about normal, day-to-day issues involving health, family, work, and money. They often jump to the worst-case scenario when analyzing situations.

Panic Disorder

Patients with panic disorder have sudden, crippling attacks of fear when there is no actual danger. These attacks are characterized by feelings of impending doom and loss of control.

Social Anxiety Disorder

Social anxiety disorder is diagnosed when patients feel extremely anxious and self-conscious in everyday social environments. They often fear being judged or watched by others, and they may be easily embarrassed.

Specific Phobia

Specific phobia is characterized by a cutting fear of something that poses little to no danger, such as small spaces, heights, water, objects, and animals. For many patients, simply thinking about facing a fear can trigger a panic attack or severe anxiety.

Other anxiety conditions recognized in the DSM-5 include separation anxiety disorder, obsessive-compulsive disorder, selective mutism, and substance-induced anxiety disorder.

2. Anyone can have anxiety, but some types disproportionally affect women.

Data collected by the National Institute of Mental Health revealed that within a 6-month period, 6% of men and 13% of women experience some form of anxiety. Women are also twice as likely as men to have panic disorder.

In general, women and men show strong differences in how they respond to stress.

Compared with men:

· Women report higher stress levels. Married women report more stress than their single counterparts.

· Women under stress are more likely to describe their life as out of control.

· Women report increasing stress throughout their lives, mostly due to balancing employment and family needs.

· Women report increased physical and emotional reactions, including crying, stomachaches, fatigue, and irritability.

· Women experience higher rates of stress-induced insomnia.

3. The signs and symptoms of anxiety can vary.

Patients with GAD show distinct, stress-related physical symptoms, including muscle tension, shortened or fragmented sleep, or an upset stomach.

Meanwhile, patients with panic disorder may mistake their panic attacks with physical symptoms. Those who have panic attacks often report believing that they’re having a heart attack, losing their mind, or dying.

Some patients, particularly men, may experience anger and aggression as a result of their anxiety.

Additionally, evidence suggests that asthma patients with anxiety may exhibit more severe symptoms.

4. Several drug classes can serve as appropriate medication therapy for anxiety.

A treatment plan for patients with anxiety may include 1 or more of the following drug classes:

Benzodiazepines

Benzodiazepines rapidly relieve the symptoms of anxiety and are also useful for intermittent and episodic symptom flares.

However, this drug class isn’t appropriate as first-line or monotherapy for GAD because it doesn’t treat the underlying cause of the anxiety, but rather masks the symptoms. Therefore, benzodiazepines are best used for acute symptom relief.

Commonly used benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are used to treat the underlying cause of anxiety, though greater symptoms may be seen within the first few weeks of use.

Common SSRIs used to treat anxiety include fluoxetine (Prozac), sertraline (Zoloft), Celexa, paroxetine (Paxil), and escitalopram (Lexapro).

Pharmacists should advise patients taking SSRIs to avoid drinking alcohol regularly and that use of some agents is contraindicated in those with narrow-angle glaucoma and liver or kidney disease.

Side effects may include low libido, increased blood pressure, blurred vision, or drowsiness.

Tricyclic Antidepressants

Examples of tricyclic antidepressants indicated to treat anxiety include maprotiline (Ludiomil), doxepin (Silenor), and clomipramine (Anafranil).

Pharmacists should closely monitor elderly patients and those with a history of seizure, cardiac issues, glaucoma, and urinary problems.

Side effects of tricyclic antidepressants may include dry mouth, constipation, low libido, and blurred vision.

Monoamine Oxidase Inhibitors (MAOIs)

Although MAOIs aren’t typically used as first-line treatment, some health care providers prescribe them for patients with anxiety.

Examples of MAOIs sometimes used to treat anxiety include phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).

Patients should avoid taking MAOIs concomitantly with OTC decongestants, cold remedies, or any medication containing tyramine. Pharmacists should also emphasize dietary restrictions for patients taking MAOIs, as the medication should not be mixed with food containing tyramine, including some cheeses, wine, and pickles.

Beta-Blockers

On their own, beta-blockers aren’t an effective anxiety treatment option, but concurrent use with another drug indicated for anxiety may help treat or prevent the physical symptoms of anxiety disorders, including trembling and sweating.

Beyond pharmacological remedies, psychotherapy or counseling can be beneficial for patients with anxiety.