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Background: The unprecedented and unaccounted use of benzodiazepines is running havoc in many countries in terms of substance abuse problems and is exponentially increasing. The prescription of benzodiazepines should be minimized and the search for and use of better alternatives be incorporated into clinical practice of Psychiatry. Aim: The aim of this study is to compare the efficacy of low dose risperidone and relatively higher dosage of clonazepam in moderate to severe anxiety states when used in combination with an SSRI. Method: A group of 60 patients having moderate to severe anxiety level, as measured by Hamilton Anxiety Rating Scale (HARS) were randomly divided into two groups. First group was given 1 mg risperidone with 50 mg Sertraline and the second group was given 3 mg of clonazepam with 50 mg Sertraline. The anxiety levels of patients in both groups were again calculated on the 10th post treatment day and compared to each other. Moreover, the Side Effect profiling of Risperidone was also done in all the Patients by using the Glasgow Anti-psychotic Side-effect Scale (GASS)’. Result: The first group had a decrease in the HARS scores having a value of 19.56 between day 0 and day 10. The second group also showed a decrease in the anxiety levels with a mean HARS score of 31.12 on day 0 to 12.36 on day 10. The mean value of decrease in HARS score was comparable. Conclusion: The efficacy of low dose risperidone is comparable to that of relatively high dose of clonazepam in treating moderate to severe anxiety states. Use of risperidone for symptomatic relief from anxiety is a viable alternative to benzodiazepines. effect with a GASS score of 5 and 8 respectively. CONCLUSION/DISCUSSION The above mentioned results of the study provide evidence that the use of a dosage, as low as 1 mg of Risperidone, not only showed significant decrease in the level of anxiety experienced by patients having MDD, OCD and GAD but also caused none or minimal/mild side effects in terms of EPS, drowsiness and weight-gain. These findings suggest that Low-dose administration of Risperidone in treatment of moderate to severe anxiety states associated with MDD, GAD and OCD can be considered over the use of high dose of benzodiazepines which have a high addictive potential among other side effects. Moreover, the reduction in the anxiety level of patients, as calibrated on the 10th day, has to be attributed predominately to Risperidone or Clonazepam, as the SSRI shows its full effect only after two to three weeks. An additional benefit in the use of low dose risperidone is that, risperidone will also augment the action of any anti-depressant that the physician may be using as a primary drug for the treatment of the Major Depressive Disorder, Obsessive Compulsive Disorder and Generalized Anxiety Disorder and render the treatment with an anti-depressant for these disorder a “push” or “head-start”, so to speak. Anxiety levels in patients with OCD showed maximum amelioration with risperidone. This could be attributed to a possible anti-obsessional effect of risperidone. There is some evidence that adding quetiapine or risperidone to antidepressants increases its efficacy, but this must be weighed against less tolerability and limited data [8]. The unprecedented and unaccounted use of benzodiazepines is running havoc in many countries in terms of substance abuse problems and is exponentially increasing as more and more people are getting introduced to this class of drugs. The prescription of benzodiazepine should be minimized as much as possible to counter the related addiction problems and the search for and use of better alternatives should be incorporated into clinical practice of Psychiatry. The challenge in this suggested usage of risperidone remains the social stigma attached with the usage of antipsychotics, personal biases of treating physicians and lack of scientific documentations in favor of this algorithm at a larger scale. CONFLICT OF INTEREST

national journal of health sciences

Adjunct Use of Low Dose Risperidone Verses Adjunct Use of Clonazepam with an SSRI in Treatment of Moderate to Severe Anxiety States; A Comparative Study