Discussion: Anxiety
Use of Benzodiazepines in Managing Anxiety Disorders
Benzodiazepines promote the activity of the gamma-aminobutyric acid (GABA) in the central nervous system, which has an anxiolytic action, sedative effects, and relaxes muscles. They serve as the short-term treatment of acute anxiety, panic attacks, and severe exacerbation of generalized anxiety disorder (GAD). They have a rapid onset, which offers relief of somatic symptoms of tremor and palpitation, which can be effectively used as a bridging treatment until these first-line agents are effective, such as selective serotonin reuptake inhibitors (SSRIs) (Bounds & Patel, 2024). Essentially, benzodiazepines are used for short-term relief, and the threat of dependence, tolerance, and withdrawal governs their usage.
Comparison of Indications, Half-Lives, Contraindications, and Risks
Benzodiazepines are categorized by half-life: short-acting, such as alprazolam, 6 to 12 hours to provide immediate symptomatic relief; intermediate, such as lorazepam, 10 to 20 hours to have a moderate duration; and prolonged-acting, such as diazepam, 30 to 60 hours to provide extended therapy. The risk of rebound anxiety is greater with the short-acting agents, and long-acting agents induce long-lasting sedation (Edinoff et al., 2021). The severe respiratory insufficiency, dysosmias and sinus, sleep apnea, myasthenia gravis, acute narrow-angle glaucoma, and the use of CNS depressants together are its contraindications. The adverse outcomes are risks of sedation, psychomotor impairment, memory loss, paradoxical agitation, dependence, and withdrawal. The risks of falls and cognitive disturbances are increased in older adults.
Non-Benzodiazepine Medication
Buspirone, a 5-HT1A partial agonist, does not sedate or relax muscles, but still increases serotonergic activity. It is approved to treat GAD but not acute panic because of its onset of 1-3 weeks. Initial dose: 7.5 mg bid, increased 2-3 days twice per day to 20-30 mg/day in divided doses; half-life 2-3 hours (Kaufmann et al., 2020). Dizziness, headache, and nausea are side effects. It is contraindicated when combined with monoamine oxidase inhibitors (MAOIs) or when there is hypersensitivity to the drug. Patients are encouraged to remain on it regularly, expect delayed effects, not terminate abruptly, and informed that it does not stop the withdrawal of benzodiazepine.
Monitoring Response to Medication
It is possible to monitor the reaction to anxiety medication through standard tools, including the GAD-7 scale, during baseline visits and at subsequent visits. It gives objective information about changes in symptoms and informs dose alterations and the decision toward treatment (Sapra et al., 2020). Regular monitoring guarantees the effectiveness of therapy, helps to reveal undesirable effects at the earliest stages, and enhances cooperation between patient and provider.
References
Bounds, C. G., & Patel, P. (2024, January 30). Benzodiazepines. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470159/
Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, dangers, and clinical considerations. Neurology International, 13(4), 594–607. https://doi.org/10.3390/neurolint13040059
Kaufmann, C. N., Moore, A. A., Bondi, M. W., Murphy, J. D., Malhotra, A., & Hart, L. A. (2020). Association between the use of non-benzodiazepine hypnotics and cognitive outcomes: A systematic review. Current Sleep Medicine Reports, 6(1), 11–20. https://doi.org/10.1007/s40675-020-00163-1
Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus, 12(5), e8224 https://doi.org/10.7759/cureus.8224
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Question 
Discussion – Anxiety
Discuss the use of benzodiazepines in managing anxiety disorders.
Compare the indications, half-lives, contraindications, and risks of use for each category.
Choose one non-benzodiazepine medication and discuss its mechanism of action, dosing, side effects, contraindication, and half-life. Include any pertinent patient education topics.
Name one way to monitor the response to the medication.
APA format
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