Anxiety

Clinical Update

Quetiapine Reconsidered

Topics: Antipsychotics | Anxiety | Bipolar Depression | Depression | Dosing | Psychopharmacology | Psychopharmacology Tips | PTSD | Quetiapine | Schizophrenia

It is the best of drugs; it is the worst of drugs. Quetiapine (Seroquel) has benefits in some disorders that are unmatched by other medications, but it is also one of the most difficult antipsychotics to tolerate. In this article, I’ll look at where this medication fits and whether its numerous off-label uses are justifiable, including PTSD, generaliz

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Expert Q&A

Benzodiazepines: A Reevaluation of Their Benefits and Dangers

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Hypnotics

TCPR: Benzodiazepines were the most commonly prescribed drug—of all drugs—in the 1970s. Are they still that popular? Dr. Salzman: I think benzodiazepines are still widely used, both appropriately and inappropriately. The SSRIs were supposed to replace the benzos for long-term treatment of anxiety, but while the use of these antidepressants has in

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Uncommon Tips

Uncommon Tips: Which Is Better—Citalopram or Escitalopram?

Topics: Anxiety | Citalopram | Depression | Escitalopram | SSRIs

Editor’s note: We’re pleased to introduce the new feature “Uncommon Tips.” In this series, Dr. Aiken will discuss little-known pearls about commonly used medications. The series starts with a comparison of citalopram and escitalopram. The rivalry between these two SSRIs began in 2002 when the Lundbeck pharmaceutical company split citalopram (

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Research Update

SSRIs vs SNRIs in Pediatric Anxiety Disorders: Which Are More Tolerable?

Topics: Anxiety | efficacy | Obsessive Compulsive Disorder | OCD | Serotonin Norepinephine Reuptake Inhibitors | Serotonin Specific Reuptake Inhibitors | Side Effects | SNRIs | SSRIs

REVIEW OF: Mills JA and Strawn JR, J Am Acad Child Adolesc Psychiatry 2020;59(11):1240–1251 STUDY Type: Meta-analysis For children with anxiety disorders and OCD, SSRIs produce faster and greater improvement than SNRIs (Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2). Unfortunately, adverse effects slow down our dose

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Research Update

Heart Rate Changes Linked to ­Emotional Dysregulation

Topics: ADHD | Anxiety | attention | Conduct Disorder | Depression | Dysregulation | Emotional dysregulation | Heart rate

Review of: Deutz MH et al, J Am Acad Adolesc Psychiatry 2019;58(6):589–599 Can we use heart rate to assess and track psychopathology? Child psychiatrists associate lower resting heart rate (HR-rest) and heart rate reactivity (HR-reactivity) with externalizing behaviors such as disruptive behaviors and aggression (“under-arousal”) and elevations

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Research Update

Prescribing Patterns for Children With Anxiety Disorders

Topics: adolescents | Anxiety | Child Psychiatry | children | Medication | prescribing patterns | Research Update | teens | treatment pediatric

Review of: Bushnell GA et al, J Clin Psychiatry 2018;79(1):pii:16m11415 Anxiety disorders are some of the most common conditions we encounter in children and adolescents, and clinicians employ a variety of medications to treat them. This study examined prescribing patterns for the initial treatment of pediatric anxiety. Researchers analyzed a larg

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Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

Topics: Anxiety | Clinical practice | Deprescribing | Free Articles | Pharmacology | polypharmacy | prescribing patterns | Risk Management | Sleep | Sleep Disorders

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

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Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Deprescribing | Generalized Anxiety Disorder | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | prescribing patterns

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

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Expert Q&A

Thyroid Augmentation in Bipolar Disorder

Topics: Anxiety | Bipolar Disorder | Depression | Laboratory Testing in Psychiatry | Mania | Pharmacology | Side Effects

TCPR: When do you use thyroid augmentation in bipolar disorder?Dr. Kelly: It may be useful for treatment-resistant bipolar depression, and I emphasize treatment-resistant because that is where the empiric support lies. Now, the evidence is not rock-solid, but when it comes to treatment-resistant bipolar depression we don’t have much else to draw on ex

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In-Brief

A Longer Acting Lorazepam

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | extended-release | Sleep

Lorazepam (Ativan) received a new coating this year as Loreev XR, which promises a 24-hour duration for this benzodiazepine that is otherwise divided in two or three daily doses. It joins alprazolam (Xanax) as the only benzos with extended-release (XR) formulations (clorazepate ventured into this territory as Tranxene SD in 2002, but that medication is

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Clinical Update

An Off-Label Guide to Gabapentin

Topics: Alcohol use disorder | Anxiety | Anxiety Disorder | Cannabis | Free Articles | gabapentin | Pregabalin

Gabapentin (Neurontin) is not a medication that would make the FDA proud. Less than 1% of its outpatient use is for an FDA indication, and a good portion of the off-label use takes place in psychiatry. These trends sparked a backlash in the 2000s, when Pfizer paid a $1.3 billion fine for misleading marketing practices. Recent reports of misuse of gabape

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Clinical Update

Buspirone: Still Effective After All These Years?

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Buspirone | GAD | Generalized Anxiety Disorder | Lavender | Medication | Melatonin | Pharmacology | Pregnancy | Psychopharmacology | Silexan

When buspirone was released in 1986, it was advertised as providing “a different kind of calm.” Unfortunately, physicians and their patients weren’t ready to accept the kind of calm that required several weeks to take effect, when punchier, quicker benzos were the standard route to tranquility. Although buspirone is FDA approved for generalized an

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Research Update

Rest Easy: Benzos, Z-Drugs, and Dementia

Topics: Anxiety | Benzodiazepines | Dementia | Deprescribing | Generalized Anxiety Disorder | Geriatric Psychiatry | Hypnotics

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

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Clinical Update

Silexan: A Novel Anxiolytic

Topics: Alternative treatments | Anxiety | Anxiety Disorder | Complementary treatments | GAD | Generalized Anxiety Disorder | Lavender | Natural Medications | natural treatments | Novel Medications | Silexan

Patients with generalized anxiety disorder (GAD) often look to medications for help, but GAD is one of the disorders where medications are likely to disappoint. Effect sizes tend to fall in the small range (0.2–0.3) with meds for GAD, including SSRIs, SNRIs, buspirone, and pregabalin (Lyrica). Only the benzodiazepines have an effect in GAD that’s bi

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Ask The Editor

Is Paxil the Best SSRI for Anxiety?

Topics: Antidepressants | Anxiety | Anxiety Disorder | Generalized Anxiety Disorder | Panic Disorder | Pharmaceutical Industry | Pharmacology | Pharmacology Tips | Practice Tools and Tips | Psychopharm Myths | Psychopharmacology | Psychopharmacology Tips | PTSD | Social Anxiety Disorder | SSRIs

Dear Dr. Aiken: Your review of Paxil’s risks in the May issue failed to mention a benefit that’s unique to this drug. Isn’t it the best SSRI for anxiety? Dr. Aiken: Paroxetine’s (Paxil’s) reputation as the anti-anxiety SSRI got off to a running start. It was first launched for panic disorder in 1996, two years before its approval for depres

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Expert Q&A

Building Self-Regulation in Children

Topics: Anxiety | Child Psychiatry | Self-Regulation

“Self-regulation” has become a buzz phrase to help children manage stress, become resilient, and stave off depression, anxiety, and post-traumatic stress disorder. To gain a better understanding of this concept, we interviewed Stuart Shanker, PhD, founder and CEO of the MEHRIT Centre (https://self-reg.ca). Dr. Shanker sets up self-regulation program

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Article

Prescription CBD Is Available, But Are We Ready to Use It?

Topics: Anxiety | Cannabidiol | Free Articles | Psychopharmacology

Your patient comes in with a new medication on his list: CBD oil. He started taking it for anxiety and wants to know if it’s safe. You hedge, explaining that there is limited information available on unregulated products, but the patient is persistent. He says CBD oil is available as a prescription, and wonders if you could write one for it. Cannab

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Expert Q&A

Anxiety Everywhere: Grappling With a Pervasive Symptom

Topics: Anxiety | Child Psychiatry

CCPR: Can you tell us a little about your background? Dr. Rynn: I’ve been doing clinical research examining new medications for children with anxiety disorders. My passion is working with children who have failed first-line, evidence-based treatments. How do we help these children? What are our options? I look at new treatments or changing the intens

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Research Update

How Effective Are Medications for Pediatric Anxiety?

Topics: Anxiety | Research Update

Review of: Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2 Antidepressants are part of the first-line treatment for severe childhood anxiety disorders when removal of stressors and psychotherapy are not enough, but are all antidepressants created equal in this situation? A recent meta-analysis shows that antidepressants

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Article

Benzodiazepines for Anxiety: Where They Fit In

Topics: Anxiety | Anxiety Disorder | Free Articles | Registered Articles

Benzodiazepines (BZDs) are widely used, rarely studied, and much maligned. So where exactly do they fit in today’s medication arsenal for treating anxiety? In this article, I will discuss when BZDs are appropriate and when they are not, and how to choose among the various BZDs. But before doing so, let’s first address the elephant that always see

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