Which medications in the drug class Antipsychotic Agent are used in the treatment of Anxiety Disorders?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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Answer

Antipsychotic Agent

Atypical and typical antipsychotic medications are generally used more as augmentation strategies and are second-line treatment options in generalized anxiety disorder. [74] Mechanisms of action generally include a combination of neuroreceptor blockade (generally dopaminergic blockade) as well as up- and downregulation of receptor sensitivity.

All drugs in this class may increase risk of life-threatening neuroleptic malignant syndrome, acute dystonias, tardive dyskinesia, weight gain, metabolic syndrome, and potential to cause diabetic ketoacidosis as well as stroke, hypertension, hypotension, or sudden death from cardiac conduction or cardiac electrophysiological abnormalities. Quetiapine has a pending application for approval by the FDA for use in generalized anxiety disorder as well as in major depressive disorder for patients whose symptoms do not remit with other treatments as it seems that low doses (50-300 mg range) of quetiapine may not be associated with the risk of hyperglycemia and metabolic syndrome that potentially can occur in higher dosage ranges or with other antipsychotic medications.

Risperidone (Risperdal)

Binds to dopamine D2 receptor with a 20-times lower affinity than for the 5-HT2 receptor. Improves negative symptoms of psychoses and reduces incidence of extrapyramidal adverse effects.

Response to antipsychotics is less dramatic than in true psychotic Axis I disorders, but symptoms such as anxiety, hostility, and sensitivity to rejection may be reduced. Antipsychotics are typically used for a short time while the symptoms are active.

Aripiprazole (Abilify)

Improves positive and negative schizophrenic symptoms. The mechanism of action is unknown but is hypothesized to work differently than other antipsychotics. Aripiprazole is thought to be a partial dopamine (D2) and serotonin (5HT1A) agonist and antagonize serotonin (5HT2A). Additionally, no QTc interval prolongation was noted in clinical trials. Available as tab, orally disintegrating tab, or oral solution.

Quetiapine (Seroquel)

May act by antagonizing dopamine and serotonin effects.

Newer antipsychotic used for long-term management. Improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia. Immediate- and extended-release formulations available.

Haloperidol (Haldol)

DOC for patients with acute psychosis when no contraindications exist. Haloperidol and droperidol (below) are of butyrophenone class, and are noted for high potency and low potential for causing orthostasis. However, the potential for EPS/dystonia is high.

Parenteral dosage form may be admixed in same syringe with 2-mg lorazepam for better anxiolytic effects.

Clozapine (Clozaril)

Demonstrates weak D2-receptor and D1-receptor blocking activity, but noradrenolytic, anticholinergic, antihistaminic, and arousal reaction inhibiting effects are significant. Also possesses antiserotonergic (5-HT1c, 5-HT2, 5-HT3) properties. Affinity for mesolimbic D4 dopamine receptor accounts for striking effects in control of behavioral and psychiatric symptoms with low incidence of extrapyramidal symptoms. Histamine receptor blockade accounts for increased incidence of sleep disturbances. Associated with a risk of agranulocytosis when used at doses required for treatment of patients with schizophrenia whose symptoms are refractory to standard neuroleptics. In US, weekly dosing and weekly CBCs are required for clozapine to be dispensed; discontinuing therapy at first sign of leukopenia decreases but does not eliminate risk of agranulocytosis; whether agranulocytosis is associated with low doses in treating elderly patients and those with dementia is not clear.

Olanzapine (Zyprexa)

May inhibit serotonin, muscarinic, and dopamine effects. Response to antipsychotics is less dramatic than in true psychotic Axis I disorders, but symptoms such as anxiety, hostility, and sensitivity to rejection may be reduced. Antipsychotics are typically used for a short time while the symptoms are active.


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