Anxiolytics are generally avoided in the management of nonulcer dyspepsia because of the potential for habituation and abuse. There are, however, two scenarios in which these agents appear helpful. The first is in the management of patients with anxiety or panic disorders who have prominent dyspeptic features (Henningsen et al, 2003). Anxiety and panic may be associated with both symptom generation and enhanced symptom perception and decreased symptom tolerance. Additionally, a subset of patients with panic disorders may present with digestive symptoms (most often nausea) in the absence of more classic anxiety symptoms. The SCL-90-R is useful in identifying these patients, as are two other instruments, the Beck Anxiety Index and Spielberger State-Trait Anxiety Index. The second group that may benefit from anxiolytics is made up of patients with persistent nausea and vomiting. Nausea is an easily conditioned behavior, as has been repeatedly seen in patients with chemotherapy-induced nausea and vomiting. Lorazepam (Ativan) is often effective in treating these patients because of its antiemetic and anxiolytic properties.

Buspirone (BuSpar) is an anxiolytic that has fallen from favor in psychiatry but has gained favor in gastroenterol-ogy. It is a 5-HTia agonist that causes fundal relaxation (Coulie et al, 1997). In healthy controls it has been shown to significantly decrease postprandial symptom scores. Although therapeutic trials are needed, our anecdotal experience with this agent in upper abdominal bloating and early satiety has been quite positive. Other fundal relaxants include sumatriptan (Imitrex), tegaserod (Zelnorm), parox-itene (Paxil), and citalopram (Celexa). All require clinical evaluation.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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