Treating Anxiety and Stress Disorders

Treating Anxiety and Stress Disorders

Fluoxetine is an FDA-approved antidepressant medication that, along with other antidepressant medications, has been used in the pharmacotherapy of depressive disorders. Fluoxetine belongs to the pharmacologic class of selective serotonin reuptake inhibitors (SSRIs). SSRIs are first-line agents in the management of anxiety and stress disorders. This paper details fluoxetine as an SSRI with antianxiety activity.

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Biological Actions of Fluoxetine

Serotonin is a biological amine that functions as a neurotransmitter and has integral physiologic functions in the central nervous system. This neurotransmitter regulates physiologic activities of mood, activity, and behavior. Upon its release into the synaptic cleft, serotonin causes physical and neuropsychiatric adrenergic responses such as tachycardia, tachypnea, increased blood pressure, agitation, and delirium. (Bamalan et al., 2022). At the postsynaptic membrane, serotonin binds to metabotropic G protein serotonin receptors and stimulates a downward second messenger cascade, which causes different effects at the organ level.

Fluoxetine is a selective serotonin reuptake inhibitor. It has an antagonistic effect on the serotonin receptors (5-HTR). The presynaptic serotonin receptors (5-HTA1) are located at the dorsal raphe nucleus and are responsible for serotonin reuptake from the synaptic cleft. These receptors are projected towards the prefrontal cortex. Fluoxetine binds to and inhibits the serotonin transport protein (SERT), thus blocking serotonin reuptake. This increases the concentration of serotonin in the synaptic cleft and consequently resets the feedback loop in the intraneural synapses.

Fluoxetine also has a mild 5-HT2c receptor antagonism. 5-HT2c receptors play a role in appetite, monoaminergic transmission, endocrine secretion, mood, and motor behavior. Fluoxetine binds to the postsynaptic 5-HT2c receptors and causes antagonistic effects. Acute antagonism on these receptors results in marked anxiolytic effects and antidepressant effects. Blockade of the 5-HT2c receptors also increases dopaminergic and adrenergic outflow, often characteristic of other SSRIs.

Fluoxetine is also a mild noradrenergic transporter (NET) inhibitor. This inhibition causes a reduction in the reuptake of adrenaline with a consequent increase of adrenaline in the synaptic cleft. Fluoxetine’s adrenergic activity has been associated with this effect. Increased adrenergic activity is seen in higher heart rates, breathing rates, increasing blood pressure, and mydriasis, among others.

Fluoxetine produces several effects on the brain. Through its serotonin reuptake-blocking effects, this drug causes stimulation and excitement in the brain. The physiologic effects are often seen in alertness, insomnia, confusion, and anxiety. Additionally, due to excessive stimulations of cardiovascular centers, tachypnea and arrhythmias are apparent. Serotonin’s interaction with the postsynaptic receptors causes a G protein-modulated downward cascade, resulting in nausea and vomiting. Interaction of fluoxetine with the 5-HT2c receptors in the postsynaptic membrane also causes dopaminergic outflow with consequent euphoria and excitation.

Behavioral and Psychological Effects

Fluoxetine affects behavior and mood. These effects are due to serotonin, which plays a role in memory, learning, sleep, sexual behavior, and hunger. Serotonin is involved in the hypothalamic regulation of the adrenocorticotropin and cortisol, which controls circadian rhythm and sleep. Serotonin also affects food behavior and is thought to decrease food consumption. Fluoxetine, through its 5-HT2c receptor antagonism, causes dopaminergic outflow. Dopamine and serotonin regulate sexual desires. These hormones also cause excitement and euphoria and have been shown to affect functions like memory and learning. The basis for the use of fluoxetine for psychiatric illness is its effects on serotonin and the neuropsychiatric functions of this hormone. Fluoxetine increases the concentration of serotonin in the synaptic cleft, thereby increasing the effects of serotonin. It also has a dopaminergic activity responsible for the dopaminergic effects on behavior seen when this drug is administered.

Fluoxetine has several behavioral side effects. Serotonin syndrome is the most pronounced side effect of fluoxetine. Serotonin syndrome is a serotonin excess disorder that results from the use of SSRIs. Serotonin syndrome defines a clinical constellation of mental, autonomic, and neuromuscular changes that occurs in an overdose of fluoxetine or when taken with other agents that potentiate its effects. Confusion, insomnia, and agitation are behavioral signs of serotonin syndrome (Carratalá-Ros et al., 2021). Others include muscle rigidity, loss of muscular coordination, headaches, tremors, and high fever.

Other behavioral side effects of fluoxetine include anxiety, nervousness, decreased libido and arousal, induction of mania, and activation of suicidal tendencies and ideation. These side effects result from serotonin excess due to reduced reuptake. Anxiety, agitation, and insomnia are often due to 5-HT2c receptor antagonism and result from the increased dopaminergic outflow. These side effects usually disappear with therapy. Waiting for the side effects to subside is the best course of management. However, if these signs persist, dose reduction, substitution, or withdrawal is warranted (Carratalá-Ros et al., 2021). Serotonin syndrome is a life-threatening side effect that often deserves treatment stoppage with SSRIs.

Anxiety Disorder

Anxiety disorder is a behavioral disorder characterized by intense fear. This disorder is characterized by cognitive, mental, physical, and behavioral orientation, preparation, and anticipation for a perceived threatening event. In pathologic anxiety, the perceived threat is often overestimated by the individual and may be perceived otherwise by others. Fear is the most common presentation of anxiety disorders. Others are trembling, sweating, nervousness, hyperventilation, and increased heart rate. Healthcare systems often overlook anxiety since its reporting is often not accurate. However, it remains one of the most common psychiatric illnesses (Ströhle et al., 2018). Anxiety has a multifactorial cause, with genetics, childhood experiences, substance abuse, and medication being implicated as causal factors.

How Fluoxetine Treats Anxiety Disorder

Fluoxetine maintains effectiveness against anxiety disorder. Together with other SSRIs, they are the first-line agents in the management of anxiety disorders. Fluoxetine increases the concentration of serotonin in the synaptic cleft and consequently increases serotonergic effects. Serotonin has an anxiolytic impact and causes calmness in an individual (Sohel et al., 2022). The strength of fluoxetine as used against anxiety disorders is its effectiveness. It remains effective against mild and severe forms of anxiety. It also has a longer half-life compared to other SSRIs. The weakness of fluoxetine as an antianxiety medication is its toxicity profile and drug interactions. Serotonin syndrome is a significant side effect of fluoxetine and other SSRIs that may limit their use, especially in combination with other agents. Its long half-life means it requires more extended washout periods before initiating MAOIs. Fluoxetine is a CYP2D6 substrate and can thus interact with other substrates of this enzyme, such as risperidone and amitriptyline.

Fluoxetine remains an effective antianxiety agent. Its effectiveness in alleviating the symptoms of the disease makes it valuable in the pharmacotherapy of anxiety disorders. It is also helpful in treating stress and depressive disorders. Fluoxetine, like other SSRIs, is the first line in the management of anxiety disorders. This notwithstanding, an overdose of these medications may result in life-threatening serotonin syndrome.

 References

Bamalan, O., Moore, M., & Khalili, Y. (2022). Physiology, Serotonin. Ncbi.nlm.nih.gov. Retrieved 21 September 2022, from https://www.ncbi.nlm.nih.gov/books/NBK545168/.

Carratalá-Ros, C., López-Cruz, L., Martínez-Verdú, A., Olivares-García, R., Salamone, J., & Correa, M. (2021). Impact of Fluoxetine on Behavioral Invigoration of Appetitive and Aversively Motivated Responses: Interaction With Dopamine Depletion. Frontiers In Behavioral Neuroscience, 15. https://doi.org/10.3389/fnbeh.2021.700182

Sohel, A., Shutter, M., & Molla, M. (2022). Fluoxetine. Ncbi.nlm.nih.gov. Retrieved 21 September 2022, from https://www.ncbi.nlm.nih.gov/books/NBK459223/.

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2018.0611

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Describe a medication used to treat an anxiety or stress-related disorder, describe the disorder, and analyze how the drug treats the disorder (4-5 double-spaced pages).

Treating Anxiety and Stress Disorders

Introduction
In this assessment, you will explore the emotions of fear, anxiety, and stress. The medications that are used to treat these anxiety and stress-related disorders can differ from the ones used to treat mood disorders.
Overview
For this assessment, you will choose a medication used to treat anxiety, OCD, or PTSD. Then, you will write about the medicine you selected, the stress or stress-related disorder the medication treats, and how the medication treats the disorder.
Instructions
In 4-5 double-spaced pages, utilizing at least three resources, complete the following:
• Describe the medication you chose, including:
• The biological actions and effects of the medication.
 The neurotransmitters affected and what effects each neurotransmitter has.
 Whether it is a drug agonist or drug antagonist.
 How the medication affects the brain.
The behavioral and psychological effects of the medication.
 The therapeutic effects of the drug affect mood and behavior.
 The side effects of the drug affect mood and behavior.
• Describe the anxiety or stress disorder (anxiety, OCD, or PTSD) that the medication treats.
Common symptoms of the disorder.
• Analyze how the medication treats the disorder.
Include strengths and weaknesses of using this medication to treat the disorder.
You can use the following sources to find more information about your chosen medication:
• Prescribers’ Digital Reference (PDR). (n.d.). https://www.pdr.net
• You can access basic information about medications without a login; type the name of the medication in the search area. The PDR has been the standard go-to for medication information for several years and is considered one of the more credible sources.
• U.S. Food & Drug Administration. (n.d.). Information for consumers and patients | Drugs. https://www.fda.gov/drugs/resources-you-drugs/information-consumers-and-patients-drugs
• You can access the FDA’s information on several medications using the search feature. Government websites are an excellent source of credible information and often a primary source for demographic information and other statistics.
Once you’ve gathered information from one or both of the above websites, find two scholarly sources to use.
Competencies Measured
By completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
• Competency 1: Explain the biological effects of psychoactive substances.
• Explain the biological actions and effects of the medication.
• Competency 2: Explain the behavioral and psychological effects of psychoactive substances.
• Explain the behavioral and psychological effects of the medication.
• Competency 3: Analyze the use of medication to treat specific mental health disorders.
• Describe the anxiety or stress disorder.
• Analyze how the medication treats the disorder.
• Competency 4: Apply scholarly research findings to topics in psychopharmacology.
• Use scholarly sources to support main points.