Anxiety

Anxiety Medications

SSRI:

SSRI Indications/Uses
Citalopram (Celexa®) FDA: Depression

Unlabeled:   Obsessive-compulsive disorder (OCD)

Escitalopram (Lexapro®) FDA: Major depressive disorder (MDD), generalized anxiety disorder (GAD)

Unlabeled:   Mild dementia-associated agitation in nonpsychotic patients, vasomotor symptoms associated with menopause

Fluoxetine (Prozac®) FDA: Major depressive disorder (MDD), binge-eating and vomiting in patients with bulimia nervosa, obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder (PD) with or without agoraphobia, treatment resistant or bipolar I depression (with olanzapine)

Unlabeled:   Selective mutism, mild dementia-associated agitation in nonpsychotic patients, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), fibromyalgia (FM), Raynoud’s phenomenon, paraphilia/hypersexuality, premature ejaculation

SSRI FDA Approved Indication(s)
Fluvoxamine (Luvox®) FDA: OCD

Unlabeled:   Major depression, panic disorder, mild dementia-associated agitation in nonpsychotic patients, PTSD, SAD, paraphilia/hypersexuality

Paroxetine (Paxil®) FDA:   MDD, PD with or without agoraphobia, OCD, SAD, GAD, PTSD, Premenstrual dysphoric disorder (PMDD), moderate to severe vasomotor symptoms associated with menopause

Unlabeled:   Eating disorders, impulse control disorders, mild dementia-associated agitation in nonpsychotic patients, paraphilia/hypersexuality, premature ejaculation

Sertraline (Zoloft®) FDA:   MDD, OCD, PD, PTSD, PMDD, SAD

Unlabeled:   Binge-eating disorder (BED), bulimia nervosa (BN), GAD, premature ejaculation, pruritis, separation anxiety disorder

SSRI ADE:

Insomnia: instruct patient to take in the morning

fatigue: instruct pt to take at bedtime

anxiety: lower dose. taper slowly

GI Upset: take with food

Sweating: add low dose anticholinergic. or add clonidine, mirtazapine, or cyproheptadine

Sexual dysfunction: lower to minimally effective dose, once weekly “drug holiday” before engaging in sexual activity.

 

SNRI:

SNRI Indications/Uses
Desvenlafaxine (Pristiq®) FDA: MDD
Duloxetine (Cymbalta®) FDA: MDD, GAD, diabetic peripheral neuropathic pain (DPNP), FM, chronic musculoskeletal pain

Unlabeled:   Stress incontinence

Levomilnacipran (Fetzima™) FDA: MDD
Milnacipran (Savella®) FDA: FM

Unlabeled:   MDD

Venlafaxine (Effexor®) FDA: MDD, GAD, SAD, PD

Unlabeled:   DPNP, FM, migraine prophylaxis, PMDD, vasomotor symptoms associated with menopause

SNRI ADE:

Medication Adverse Effects
Desvenlafaxine Diaphoresis, increased cholesterol/triglycerides, NV, loss of appetite, constipation, dizziness, HA, insomnia/hypersomnia
Duloxetine NV, loss of appetite, constipation, dizziness, insomnia/sedation, dry mouth, sexual dysfunction
Levomilnacipran

and milnacipran

NV, loss of appetite, constipation , HA, tachycardia, palpitations, orthostatic hypotension, HTN, hyperhidrosis, hot flashes, erectile dysfunction, ejaculation dysfunction, insomnia
Venlafaxine Nausea, loss of appetite, constipation, somnolence, dry mouth, diaphoresis, sexual dysfunction

Other agents:

Medication FDA Indication(s) Unlabeled Uses
Dopamine Reuptake Inhibitor (DRI)
Bupropion (Wellbutrin®, Zyban®) MDD, seasonal affective disorder, smoking cessation adjunct ADHD, bipolar depression

DPNP

Serotonin Antagonist/Serotonin Norepinephrine Reuptake Inhibitors
Nefazodone Depression PTSD
Trazodone (Oleptro™) MDD Augmentation, hypnotic
Noradrenergic/Specific Serotonergic Antagonist
Mirtazapine (Remeron®) Depression Alzheimer’s dementia-related depression, PTSD
SSRI/5HT1A Receptor Partial Agonist
Vilazodone (Viibyrd™) MDD
SSRI/5HT1A Receptor Agonist/5HT3 Receptor Antagonist
Vortioxetine (Brintellix®) MDD  
  • Most efficacious: Mirtazapine, escitalopram, venlafaxine, sertraline
  • Most acceptable: Escitalopram, sertraline

TCAs:

  • Amitriptyline
  • Amoxapine
  • Clomipramine (Anafranil®)
  • Desipramine (Norpramin®)
  • Doxepin (Sinequan®)
  • Imipramine (Tofranil®)
  • Maprotiline
  • Nortriptyline (Pamelor®)
  • Protriptyline (Vivactil®)
  • Trimipramine (Surmontil®)

Atypical Antipsychotics in tx of MDD:

SGA FDA Indication

Adjunct/Augmentation

Evidence for unlabeled use FDA Indication Monotherapy Evidence for unlabeled use
Risperidone No Moderate and positive No Unknown
Olanzapine Yes —- No Moderate and positive
Quetiapine Yes —- No Moderate and positive
Aripiprazole Yes —- No Unknown
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