These drugs are now used in both pediatric and adult populations across a wide and growing range of indications, which include a number of anxiety disorders. The SSRIs are listed by some as their selleck products preferred first-line treatment
for many anxiety disorders. These drugs have not to date been reported to have a propensity to cause dependence or abuse, though a “discontinuation syndrome” has Inhibitors,research,lifescience,medical been described.71-76 A panel of recognized authorities on the pharmacotherapy of anxiety and depression was near unanimous in its rating of members of the SSRI class of drugs as offering less relative risk of dependence when compared with the benzodiazepines.77 One major drawback to their use, however, has been the lag between treatment initiation and the onset, of antianxiety activity. Hence, they are not, useful for treatment, of acute anxiety. Because their use is not accompanied by the worry of dependence, they may allow more clinicians to confidently begin pharmacological Inhibitors,research,lifescience,medical treatment for patients who suffer from chronic anxiety disorders. Some clinicians have described a treatment paradigm that utilizes concomitant benzodiazepine treatment during the time that it is anticipated to be required for SSRIs to exert an anxiolytic Inhibitors,research,lifescience,medical effect. Tolerability of side effects has also been a concern with these medications.32 Sexual dysfunction and weight gain are frequently problems for patients taking these drugs over
the spectrum of indications. In addition, some patients experience initial insomnia,
restlessness, and agitation. Precipitation Inhibitors,research,lifescience,medical of overt panic attacks have also been reported.78,79 For patients who take numerous medications, such as many elderly patients, some of the SSRIs can be difficult, to blend into a medication regimen because of their ability to cause clinically important drug interactions.80 Although regarded as nonsedating and thus less likely to be a hazard for accidents and falls, it should be noted that the SSRIs have also been linked to increased falls in the elderly.81-84 The discontinuation syndrome that has been noted by Inhibitors,research,lifescience,medical many authors71-76 and investigators includes both physical and psychological symptoms, including lethargy, headache, and dizziness. The course is usually mild, with spontaneous resolution within a month. The cause may be transient serotonin dysregulation following abrupt withdrawal of an SSRI. As with the benzodiazepines, differences between SSRIs are seen with regard to their propensity to cause this syndrome following cessation. Drugs with slower clearance and pharmacologically 4-Aminobutyrate aminotransferase active metabolites, such as fluoxetine, are reported to be less likely to cause this condition when stopped as compared with a drug such as paroxetine, which is not, known to have active metabolites.76 Norfluoxetine, the active metabolite of fluoxetine, is detectable for weeks following cessation of chronic fluoxetine therapy. Tapering medication prior to stopping is suggested to minimize the discontinuation syndrome.