Magnesium supplements help with anxiety

When anti-anxiety medication can help

Initially, fear is not a disease, it can affect anyone depending on the situation. However, it can also be a symptom of a disease and occur, for example, in the context of depression or a heart attack. However, if the symptom fear is clearly in the foreground, without it being explained by psychiatric or somatic diseases, then there is a primary anxiety disorder. If the fear is situational, it is called phobias. This includes the fear of spiders as well as the fear of flying or the fear of large spaces (fear of department stores, agoraphobia). Anxiety disorders when dealing with other people, such as exam anxiety or fear of talking in front of a large crowd, are known as social phobias. Non-situational anxiety disorders include panic disorders and generalized anxiety disorder (GAS).

Panic disorders are characterized by unpredictable anxiety and panic attacks that peak after a few minutes and then slowly subside over a period of half an hour to an hour. The patients suffer from heart attack-like symptoms. They tremble, sweat, have chest tightness and shortness of breath, and are scared to death. Such attacks keep recurring. In severe cases, several times a week.

People who suffer from generalized anxiety disorder have excessive and varied worries, fears and fears that determine their lives and severely limit them.

Anxiety disorders that occur in clearly defined situations can often be successfully treated with psychotherapeutic interventions such as behavioral therapy. In contrast, drug strategies are indicated for panic disorders, generalized anxiety disorder and social phobia (see table).

Tab .: Pharmaceuticals for the treatment of anxiety disorders.
(GAS: Generalized Anxiety Disorder, PTSD: Post Traumatic Stress Disorder,
RIMA: reversible and selective inhibitor of monoamine oxidase A,
SNRI: selective serotonin and norepinephrine reuptake inhibitors,
SSRI: selective serotonin reuptake inhibitors,
TZA: tricyclic antidepressants)
[from Volz HP: Pharm Ztg Davos 2009]
Social phobia
Panic disorder
GAS
PTSD
40 – 60
40 – 60
40 – 60
50 – 60
gastrointestinal, initial paradoxical increase in fear, potential for interaction
gastrointestinal, initial paradoxical increase in fear
Social phobia
Panic disorder
GAS
gastrointestinal, initial paradoxical increase in fear
gastrointestinal, initial paradoxical increase in fear
Social phobia
Panic disorder
GAS
gastrointestinal, initial paradoxical increase in fear
anticholinergic side effects, fatigue, drop in blood pressure, cardiac conduction disorders
Fatigue, risk of developing addiction
pronounced fatigue, risk of developing dependency
Buspirone (partial 5HT1A Agonist)
Pregabalin (calcium channel
modulator)
Tiredness, drowsiness, ataxia (high doses)
Hydroxyzine
(Anti-
histaminergic)

Benzodiazepines and serotonergic substances are used for panic disorders. The latter include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, citalopram, escitalopram and sertraline, as well as the selective serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine. In severe panic attacks, one can take advantage of the rapidly occurring anxiolytic effects of intravenous diazepam treatment. However, the long-term treatment of panic disorders with benzodiazepines stands in the way of addiction potential. About 20 to 30% of those treated in this way develop corresponding problems. As an alternative, there are serotonergically active substances which, however, must initially be expected to increase anxiety during the first ten days of treatment. Only then does the anxiolytic effect occur. In order to conceal the increase in anxiety and to bridge the time until the onset of the anxiolytic effect, a benzodiazepine can be prescribed in addition to the serotonergic substance for a short period of about 14 days.

GAS: high remission rate

A wide range of serotonergic substances are available for treating generalized anxiety disorder. In addition to benzodiazepines and serotonergic substances from the SSRI and SNRI group, tricyclic antidepressants such as imipramine and opipramol, buspirone, the anti-epileptic pregabalin and the antihistamine hydroxyzine are used. Although the symptoms improve with these substances, remissions must be expected on discontinuation. For example, after stopping pregabalin therapy after six months, 35% of the patients again suffered from the symptoms of generalized anxiety disorder.

Social phobia: success with serotonergic substances

Drug treatment of social phobia is much more promising. The focus here is on serotonergic substances with which very good response rates - defined as a 50% decrease in symptoms - can be achieved. The number needed to treat (NNT) is given

  • for paroxetine with 2.9 to 3.1,
  • for fluvoxamine with 4.9,
  • for sertraline with 4.2 and
  • for venlafaxine with 6.7.

The relapse rate six months after discontinuing therapy is also low. In a placebo-controlled study, it was 4% for sertraline, and 36% for the previously placebo-treated patients.

sourceProf. Dr. Hans-Peter Volz, Werneck: Pharmacotherapy of anxiety and anxiety disorders. Presentation at Pharmacon Davos, February 9, 2009.
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