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Anxiety Part 2

Shawn Hersevoort, MD, MPH and Rob Orman, MD
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No me gusta!

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Alprazolam can cool down intense anxiety but may soon become more problem than therapy.

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mike p. -

Any considerations for low dose Clonidine for anxiety, sympathetic suppression with ETOH/drug withdrawl. Also, is there really much benifit with hydroxyzine as an adjunct to SSRI or alone to avioid benzos for mild cases?

Rob O., MD -

Hi Mike P., Here is the reply from Shawn Hersevoort
Q1: Any considerations for low dose Clonidine for anxiety, sympathetic suppression with ETOH/drug withdrawl.

A1: According to most research and expert consensus clonidine is not that useful for garden variety anxiety. It doesn't hurt, but doesn't really seem to help for things like generalized anxiety, social, OCD, panic, or phobias. What it does help is hyperactivity associated with ADHD, tics, PTSD hyperarousal and nightmare. In regard to tolerating the hyper-arousal associated with withdrawal from opiods or alcohol it can be very helpful. And, there is a growing literature that clonidine can be very helpful as a primary agent in the suppression of craving in the treatment of both tobacco and alcohol.

Q2: Also, is there really much benifit with hydroxyzine as an adjunct to SSRI or alone to avioid benzos for mild cases?

A2: Hydroxyzine has some benefit as an alternative to BZD, but not much. It is great in children who need a prn medication and you don't want to use something stronger. My favorite in adults in gabapentin 150-300 mg as an alternative to BZD.

Heidi J., MD -

Interesting! Have not seen clonidine or hydroyzine used in my neck of the woods, other than hydroxyzine for peri-procedural anxiety/sedation in kids. Will look into it.

Casey P. -

Hi Mike
Clonidine was used in the evening to help calm the ADHD kids on meds here in Australia - but it has gone way out of fashion in the last few years.
The only place we still use it is as an adjunct analgesic in kids having surgery / Anaesthesia
I use it as a backup plan in epidurals in labour or for really angry young men whom tend to wake up cranky after a GA.

It is a very ugly drug to see in OD!
Casey Parker

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My Anxieties Have Anxieties Full episode audio for MD edition 204:13 min - 96 MB - M4AHippo Primary Care RAP December 2014 Summary 787 KB - PDF

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