Pharmaceutical Care in the Use of Escitalopram in Anxiety Disorders

Abstract

As one of the most common psychiatric disorders, Anxiety more commonly occurs with other disorders rather than existing in isolation [1,12]. Early intervention is very effective in preventing cognitive, physiological, and behavioral symptoms and preventing the development of more serious mental health conditions [1, 10]. According to the DSM-5, it is divided into several types; the most frequently faced by healthcare professionals are Generalized Anxiety Disorders (GAD), Social Anxiety Disorders (SAD), and Phobic Disorders (PD) (1). GAD causes excessive, unrealistic, and ongoing concern about commonplace issues (such as money, family, health, and the future), accompanied by fear, worries, and a continual sense of being overwhelmed [4]. SAD, which is also known as social phobia, is marked by an overwhelming fear of rejection, humiliation, or embarrassment when participating in a public performance or social engagement and being subject to potential unfavorable criticism from others [5]. However, PD is accompanied by frequent, unpredictable panic attacks [6]. There is evidence that both SAD and GAD have significant rates of recurrence and/or chronic anxiety symptoms; there are several reasons why this refractory nature may exist, such as substance abuse, inadequate treatment adherence, misdiagnosis, or other comorbidities [13]. For the treatment of PD, GAD, and SAD, the Food and Drug Administration (FDA) has approved several selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Notwithstanding these labels, drugs not approved for a particular ailment are commonly used "off-label" in clinical practice. Like the FDA, the European Union has expanded indications for the use of SSRIs and SNRIs to treat anxiety disorders. As SSRIs have more efficacy and less cardiotoxicity than many first-generation antidepressants, they became the first-line treatment for GAD, SAD, and PD [13].  When considering both combined effectiveness and tolerability, Escitalopram comes first. It’s more efficacious when compared to a placebo, and there is evidence that it works better than several antidepressants. The FDA approves Escitalopram to treat GAD with 10 mg/d as an initial dosage to 20 mg/d maximum, and it is widely prescribed off-label for PD, SAD, and a variety of other psychiatric conditions [2]. Based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter, nonclinical studies have provided potential approaches by which Escitalopram could be more efficacious [3]. Pharmacists are responsible for optimizing dosages to mitigate the occurrence of manageable side effects associated with Escitalopram, including insomnia, nausea, increased sweating, fatigue, drowsiness, vomiting, and sexual dysfunction. Additionally, they ensure the avoidance of potentially harmful side effects such as bleeding, serotonin syndrome, and QT-prolongation [2]. They play a crucial role in patient education, enabling them to make well-informed treatment choices and actively participate in their healthcare. Coordinated communication between the healthcare team has a significant role in achieving the best possible outcome for the patient, preventing drug interactions, and mitigating the risk of adverse events, resulting in more effective therapeutic outcomes and a better life quality for patients suffering from anxiety.