Selective re-uptake inhibitors
Selective re-uptake inhibitors aim at blocking receptors that are responsible for the re-uptake of specific messenger substances.
According to many experts, serotonin re-uptake inhibitors induce less side effects and offer therefore more safety, while being equally efficient.
In particular, the substances fluvoxamine, fluoxetine, sertraline, paroxetine, citalopram, escitalopram and venlafaxine have all proven to be efficient in the treatment of anxiety disorders. Whether the effect is good or even better than imipramine is still not known. There seems to be no clear differences in the efficacy of each substance. Their effects are all similar to imipramine, and do not lead to dependency either.
The most important aspect is that the anxiety-reducing effect appears with some delay, while possible side effects, such as enhanced anxiety, appear at an earlier stage. This issue must absolutely be addressed with the patient. Early treatment termination can provoke withdrawal symptoms similar to the initial symptoms. It is therefore very important to reduce the dosage over a longer period of time before completely stopping the treatment. Side effects affecting the heart are rather rare. Serotonin re-uptake inhibitors can also be administered to people with glaucoma or prostate enlargement (as opposed to imipramine). Other side effects can include nausea, vomiting, restlessness, weight loss, appetite loss, headaches and sleep disturbances.
Of course, serotonin re-uptake inhibitors are not a miracle cure. Apart from the initial side effects, which usually disappear after 2 to 3 weeks, the most frequent side effect is a loss of sexual desire. As for tricyclic antidepressant, this medication should also be introduced gradually, especially with anxiety patients, as these tend to be more sensitive to side effects. It usually lasts at least 4 weeks before a distinct effect can be noticed, and 8 to 12 weeks before panic attacks have fully disappeared.
Fear of anxiety and avoidance behavior decrease as panic attacks gradually disappear. In cases where the use of antidepressant is the main treatment focus, a long-term treatment for at least a year is still to be considered. Each antidepressant aims at handling specific aspects. In this regard, much research still needs to be done.
According to current research, monoamine oxidase inhibitors (MAOIs) also prove to be efficient. Moclobemid bears less risk than other substances from the same group. Side effects include dizziness, shaking, insomnia and excitation. The onset of effects begins one or two weeks after the beginning of the treatment, and sexual desire is usually not affected.
Text: Helga Grafe – 03/2016
Translation: MyH – 05/2016