Informing Yourself About The Best SSRIs For Anxiety

Source: thebestbrainpossible.com

Anxiety is the body's automated 'alarm system,' which manifests as the so-called fight-or-flight response to a perceived threat. Feeling anxious is a normal reaction to sometimes uncontrolled or traumatic life circumstances, and is transient. Often, normal anxiety can be successfully managed in some natural, medicine-free ways. Ideally, taking scheduled or prescribed medicine should be the last line of treatment, and then only if a trained medical professional has made a positive diagnosis of an anxiety disorder.

It needs to be stressed that the doctor will ultimately decide which SSRI is best suited to treat a patient's anxiety disorder. The following is only for information purposes, and a trained doctor should always confirm self-diagnosis. Strictly refrain from taking old or expired SSRIs, or from taking someone else's SSRI without a doctor's diagnosis and prescription, as it could prove dangerous, or, in extreme cases, fatal.

SSRIs

SSRIs, or selective serotonin reuptake inhibitors, are antidepressants with an indication for long-term treatment of numerous anxiety disorders. SSRIs are the first treatment to be prescribed if your doctor suspects an anxiety disorder.

Some SSRIs differ in their chemical and pharmacological composition. Sometimes switching from one SSRI to another (intraclass switching) can have a significant effect, and is recognized as a safe treatment strategy.

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When a doctor considers an SSRI for a prescription, they keep in mind the clinically important differences between the SSRIs. These would include:

  • Efficacy across their recommended dose range
  • Efficacy in metabolism across their dose range (kinetics)
  • The speed of elimination from the body (half-life)
  • How patient age affects the drugs' elimination
  • How they affect the metabolism of other drugs

The Above Considerations Can Influence:

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  • SSRI dosing and administration
  • side-effects
  • safety when taken with other medications
  • withdrawal effects
  • and safety in the case of intraclass switching or if switching to another class of antidepressant

For this article, we will only compare the SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) with each other regarding their Indications for Anxiety Disorders, Side Effects, Drug Interactions and Withdrawal Symptoms.

Source: Medscape.com

SSRI & Indication for Anxiety Disorder Side Effects Drug Interactions Withdrawal Symptoms
Citalopram - Generalized anxiety disorder (GAD) Incidence: >10%

Dry mouth, nausea, somnolence, insomnia, xerostomia, increased sweating.

Incidence 1-10%

Tremor, diarrhea, ejaculation disorder, rhinitis, upper respiratory infection, dyspepsia, fatigue, vomiting, anxiety, anorexia, abdominal pain, agitation, impotence, sinusitis, dysmenorrhea, decreased libido, yawning, arthralgia, myalgia, amenorrhea, confusion, cough, flatulence, increased saliva, migraine, orthostatic hypotension, paresthesia, polyuria, pruritus, rash, tachycardia, weight change.

Relatively low potential for interactions with most drugs. View specific interactions here or read a package insert. Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
Fluoxetine - acute treatment of panic disorder (PD), with or without agoraphobia; obsessive-compulsive disorder (OCD) Incidence: >10%

Headache, nausea, insomnia, anorexia, anxiety, asthenia, diarrhea, nervousness, somnolence, tremor, weakness.

Incidence: 1 - 10%

Dizziness, dry mouth, dyspepsia, sweating, decreased libido, abnormal taste, agitation, chest pain, chills, confusion, ear pain, hypertension, sleep disorder, increased appetite, palpitation, sleep disorder, tinnitus, urinary frequency, vomiting, weight gain.

High potential for interactions with 30% of all drugs, including analgesics, tricyclic antidepressants, other antidepressants incl fluvoxamine, paroxetine, trazodone, bupropion; antipsychotics, diazepam, omeprazole, sertraline, S-warfarin, antiarrhythmics, beta-blockers, phenytoin, losartan, debrisoquine. For all interactions, read here, or a package insert. Suicidal thoughts and behaviors in children, adolescents, and young adults.

Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.

Fluvoxamine - social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and panic disorder (PD). Incidence: >10%

Nausea, headache, somnolence, weakness, diarrhea, dizziness, xerostomia, anorexia, abnormal ejaculation.

Incidence: 1 - 10%

Pain, dyspepsia, constipation, decreased libido, upper respiratory infections, anxiety, tremor, sweating, vomiting, abdominal pain, myalgia, abnormal taste, bruising, abnormal dreams, abnormal thinking, chest pain, palpitation, agitation, vasodilation, hypertension, elevated liver enzymes, weight change, manic reaction.

High potential for interactions with 50% of all drugs, including: antipsychotics, caffeine, analgesics, diazepam, benzodiazepine, propranolol, R-warfarin, S-warfarin, tacrine, tricyclic antidepressants, theophylline, citalopram, fluoxetine, omeprazole, paroxetine, analgesics, antiarrhythmics, anticonvulsants, antifungals, antineoplastic, buspirone, calcium channel blockers, anti-cholesterol, cisapride, clozapine, immunosuppressants macrolide antibiotics, rifampin, steroids, losartan, phenytoin, sertraline. For a complete list of drugs with the risk of interactions, read here. Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
Paroxetine - social anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder (PD),
generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD)
Incidence: >10%: Nausea, insomnia, dry mouth, headache, asthenia, constipation, diarrhea, dizziness, ejaculation disorder, tremor.

Incidence: 1 - 10%:

Anxiety, blurred vision, decreased appetite, impotence, nervousness, paresthesia, hypomania.

Moderate potential for interactions with 30% of all drugs, including analgesics, antiarrhythmics, antidepressants incl fluoxetine, fluvoxamine, paroxetine, trazodone, venlafaxine, bupropion; antipsychotics, beta-blockers, and debrisoquine. For a complete list of drugs with risk of interaction, read here or a package insert. Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
Sertraline - obsessive-compulsive disorder (OCD),
panic disorder (PD),
post-traumatic stress disorder (PTSD),
social anxiety disorder (SAD)
Incidence: >10%: Diarrhea, nausea, headache, insomnia, ejaculation disorder, dizziness, dry mouth, fatigue, drowsiness.

Incidence: 1 - 10%:

Agitation, anorexia, anxiety, constipation, paresthesia, impotence, sweating, malaise, vomiting, pain.

Relatively low potential for interactions with most drugs. Fluvoxamine, fluoxetine. For a complete list of drugs with interaction potential, read here or obtain a package insert/leaflet. Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
Escitalopram - generalized anxiety disorder (GAD) Incidence: >10%: Headache, nausea, ejaculation disorder, somnolence, insomnia.

Incidence: 1 - 10%:

Xerostomia, constipation, fatigue, decreased libido, toothache, anorgasmia, flatulence, weight gain, menstrual disorder, rhinitis, flu-like syndrome.

Contraindicated for LHRH agonists, hormone antagonists, monoamine-oxidase inhibitors (MAOIs), MAO-B inhibitors, antineoplastic, antipsychotics. For a complete list of drugs with interaction potential, read here or obtain a package insert/leaflet. Especially upon abrupt discontinuation: low/dysphoric mood, irritability, agitation,
dizziness, sensory disturbances (e.g., paresthesia such as electric shock sensations), anxiety,
confusion, headache, lethargy, emotional lability, insomnia, and hypomania.

Not an easy read, but, when it comes to medical treatments that deal with the psyche, one cannot be too informed. So, now that we have looked at some of the primary treatments, how does one decide if one needs to approach a doctor?

Distinguishing Normal Anxiety from An Anxiety Disorder

Source: cmhc.utexas.edu

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Everyone experiences anxiety from time to time. Someone with a disorder will, however, experience anxiety chronically and more severely.

Normal Anxiety Anxiety Disorder
Occasional worry about circumstances like break-up stress at work or a child's illness. Worrying constantly, chronically and without true reason so that it affects relationships, causes emotional and physical distress and interferes with functioning every day. Impaired concentration due to worrying.
Embarrassed or feeling self-conscious when facing an uncomfortable social situation. Avoiding social interaction and common social situations for fear of embarrassment, humiliation or judgment.
Experiencing physical symptoms such as the jitters, mild sweating or even dizziness over a pending big exam, business deal or an event like getting married. Repeated, random panic attacks, feelings of impending doom and terror, constant worrying over and fear of another panic attack.
Sadness, insomnia and anxiety or worry immediately following a traumatic event. These feelings eventually disappear by themselves, or after receiving therapeutic trauma counseling. Persistent nightmares, night terrors or flashbacks of a traumatic event months or even years after the event.
Realistic and appropriate fear of a threatening situation, person or object. Irrational fear, sometimes resulting in avoidance of a harmless to mildly threatening object, situation or person.
The normal need for assurance of a safe, secure and healthy environment. Irrational fears of perceived threats that result in compulsive behavior such as chronic hand-washing, over-and-over checking that a place is locked for the night, etc.

If you recognize, in yourself, any three of the symptoms listed in the right-hand column, it may be time to consider therapeutic and medical assistance. Other troubling emotional symptoms of an anxiety disorder include:

  • Feeling excessively irritable;
  • Feeling like your mind's gone blank;
  • Difficulty in concentrating.

Physical Symptoms Of Anxiety

Source: helpguide.org

Source: countryliving.co.uk

The following physical symptoms of anxiety are common, but if you have an anxiety disorder, you will frequently or chronically, and excessively experience two or more of the following:

  • Pounding heart
  • Sweating
  • Tensions headaches
  • Stomach upset and diarrhea without a material cause
  • Dizziness
  • Frequent urination
  • Shortness of breath
  • Involuntary muscle twitches; excessive muscle tension
  • Shaking or trembling
  • Insomnia

Anxiety is a common emotion we experience due to a variety of reasons. Very often, it needs no more intervention than conscious relaxation or just time out from the stressors. Sometimes, it is good to see a therapist or counselor, especially for anxiety in response to a traumatic event, or series of events. If the symptoms persist, or you present with three or more of the symptoms listed in this article, it would be prudent to see a doctor or psychiatrist.

Source: counselingtherapyonline.com

The medical professional will determine if medication is necessary, and if so, what the best SSRI for your anxiety would be. For optimum results, the doctor would advise concurrent therapy or counseling, and BetterHelp could be the perfect platform for this purpose. Our therapists and counselors are trained to deal with any anxiety disorder, increasing your chances of leading a normal, low-anxiety life again.


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