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Dr Lim Boon Leng 林汶龙医生 

Psychiatrist & Medical Director

Dr BL Lim Centre For Psychological Wellness

#09-09, Gleneagles Medical Centre, 6 Napier Rd, S258499

www.PsyWellness.com.sg 

Medications in

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Management of Anxiety 

General Considerations

Bio-Psycho-Social approach

Individualized and not standardized

Psychological treatment alone effective in

many cases

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Change is Constant . . . Turbulence is Normal . . .

Work is Relentless . . .

Accelerating

Change

Family Issues

Technology

Increased HealthConcerns

Economic

Crunch

24/7 Global

Operations

Why is this happening?

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Pharmacotherapy 

When to treat?

Risk-Benefit Assessment:

Degree of emotional distress

Degree of functional impairment

Hazards and side-effects of medication

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Pharmacotherapy 

Tricyclic Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)

Newer antidepressants

Serotonin and Norepinephrine

Reuptake Inhibitors (SNRIs)

Noadrenegic and Specific

Serotonegic Antidepressants

(NaSSAs) 

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Ant idepressants 

• Used in both anxiety and depression

• Effective in mild, moderate or severe anxiety

•

Effectiveness comparable between and withinclasses

• Improvements seen in 2 weeks; sometimes up

to 4-8 weeks

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How Ant idepressants Work 

• Normalize naturally occurring brain chemicals

called neurotransmitters

• serotonin

• norepinephrine

• dopamine

•

these particular chemicals are involved inregulating a person's anxiety and mood

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Advantages o f Ant idepressants 

• Minimal addictive potential

• No tolerance effects

•

Anti-anxiety effects even in absence of depression

• No withdrawal symptoms

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How quickly do they act?

Full effect in about 2-4 weeks

How long is the treatment? At least 6 months to 1 year

Longer for Recurrent Anxiety

“  The dose that makes them well is the dose that keeps

them well ”   

Ant idepressants 

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“It’s important to

communicate how you are

 feeling so that your physician

can evaluate the medication’seffectiveness”  

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Benzodiazepines

Commonly prescribed, effective in reducinganxiety

E.g.s Xanax (alprazolam), Ativan (lorazepam),Valium (diazepam)

Problems of dependency esp. the fast-acting BZPs

Usually used for no more than 2-4 weeks

(MOH guidelines)

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Beta-Blockers 

Beta-blockers control some of the physical

symptoms of anxiety, such as trembling and

sweating. eg. Propranolol

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“Docs too free with giving

out pills? It’s like

trafficking”  

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FAQ 

1. What are the side effects???

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Common ly Repo rted Side Effects 

• Headache (up to 10%)

• Nausea, GI discomfort (4-5%)

• Anxiety, restlessness during initiation

• Drowsiness, lethargy

• Insomnia

• Sexual / erectile dysfunction

• Side effects usually mild and last up to a week

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 Interesting Fact  

• In a study, 41% of subjects on sugar pills

(placebo) experienced the side effects that

they were told

• may not be the medication that caused the

side effect but the warning itself 

• Most likely if only inform about one side

effects

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FAQ 

2. Dr I’m not depressed. Why you give me

antidepressants??

• Antidepressants are also “anti anxiety”

medications

• Effective for Anxiety Disorders even if 

depression is not present.

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FAQ 

3. Will I get addicted?

Antidepressants:

No. They are not habit – forming and do not

produce a “high.” Once you reach a dose that

works for you, you do not require ever increasing

doses to maintain the beneficial effect

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FAQ 

4. I start already cannot stop is it? I have to

take this for life?

Once your symptoms are gone, we

recommended to stay on medications for 6-12

months

Longer if recurrent episodes.

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FAQ 

5. Can I take my antibiotics / flu meds / TCM /

Tongkat Ali with the antidepressants?

• Yes

• And please don’t stop 

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FAQ 

6. Can I not take medications?

BRA  – Understand the Benefits vs Risks (and

available Alternatives)

You have the power (and responsibility) to

decide

What else can be done?

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Psycho log ical Therapy 

The Couch?

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R.E.S.T. 

R – Rest: Accept that rest and relaxation is part

of work and plan this into your routine

E – Exercise and Eat Healthily

S – Sleep: Sleep well and maintain regular

pattern

T – Talk: Talk to your friends and family about

your stress and troubles. If needed, talk to

counsellors