The Chemistry of the Brain
Gail S. Anderson in Biological Influences on Criminal Behavior, 2019
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant drugs that are used to treat depression and other similar disorders.33 In general, they increase the levels of serotonin to improve mood and feelings of well-being. They have also been successfully used to reduce impulsive aggression in highly impulsive-aggressive individuals, and although it only completely prevents aggression in 30% of patients, almost half benefit from treatment.27 Work has shown that for SSRIs to work, the serotonin synaptic function must be working at least partially, as SSRIs attach to serotonin transporters, increasing serotonin levels within the synapse.27 Evidence suggests that low serotonin transporter numbers predispose to high levels of aggression, so fewer transporters would mean less to which the SSRIs could bind, resulting in blocking serotonin uptake and so reducing serotonin at the synapse.27 This explains why individuals carrying the S allele of 5-HTTLPR do not respond well to SSRI treatment, as they have lower levels of synthesis of the transporter protein.27 Neuroimaging studies have shown that SSRIs and other aggression treatments normalize the brain’s overreaction to threatening stimuli (from 122% to less than 0.1%).27
Anxiety Disorders: Panic, Social, Obsessive-Compulsive, Generalized, and Post-Traumatic Anxiety
Thomas L. Schwartz in Practical Psychopharmacology, 2017
Each DSM-5 anxiety disorder will have essentially the same approach to guideline-based treatment. The safer serotonergic drugs (selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox), are always preferred as a first intervention. Next, serotoninnorepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR), duloxetine (Cymbalta) may be used. Next, the clinician must weigh using a benzodiazepine (BZ) sedative-anxiolytic (alprazolam [Xanax], clonazepam [Klonopin], diazepam [Valium], etc.) with their significant addiction and psychomotor impairment risks versus use of a tricyclic antidepressant (TCA) or even a monoamine oxidase inhibitor (MAOI) antidepressant. These latter two classes do not carry an addiction risk but have greater cardiac, overdose, drug, and dietary interaction concerns. It is in these later subtle yet pivotal decision-making areas that nuances among the anxiety disorder guidelines arise. After making an accurate diagnosis, a clinician should ideally choose an FDA approved initial treatment. Below are summaries of the FDA approved medications for each anxiety disorder. For further details, the reader is referred to the quick reference Prescribing Table.
Control of symptoms other than pain
Nigel Sykes, Michael I Bennett, Chun-Su Yuan in Clinical Pain Management, 2008
A systematic review of antidepressant drug treatment showed that just over four patients with physical illness would have to be treated to produce one recovery that would not have occurred using placebo (number needed to treat (NNT) of 4.2) (95 percent confidence interval 3.2–6.4).193[I] Tricyclic antidepressants are highly effective but cause troublesome adverse effects such as postural hypotension, cardiac arrhythmias, and anticholinergic effects.Selective serotonin reuptake inhibitors (SSRIs) are an alternative – the main adverse effects are nausea, diarrhea, and insomnia. Different SSRIs also inhibit different hepatic enzymes, increasing the potential for drug interactions.194[V] However, SSRIs can usually be started at a therapeutic dose, unlike the tricyclics, which have to be built up over time.Most antidepressants require two to three weeks or longer to work. Mirtazepine, a newer antidepressant, may be an exception – it is claimed to have a faster onset of action.195[II]Amphetamines have been used anecdotally in combination with antidepressants – they may improve mood more rapidly than antidepressants.
Novel psychotherapeutics – a cautiously optimistic focus on Hallucinogens
Published in Expert Review of Clinical Pharmacology, 2018
Alexander M. Sherwood, Thomas E. Prisinzano
The therapeutic use of hallucinogens represents a potentially new paradigm in the way medicine understands and treats psychiatric illnesses. While the pharmacological diversity of hallucinogens is vast, a fascinating common phenomenon has been observed in their therapeutic utility: a single acute exposure to the hallucinogenic agent can elicit an immediate and lasting improvement in symptoms for the patient, an effect that persists long after the drug is metabolized and gone from the body [3]. This is in contrast to current pharmacotherapies used to treat mental disorders, such as selective serotonin reuptake inhibitors (SSRIs), which are based on a therapeutic model that attempts to alleviate symptoms by re-equilibrating the steady-state levels of serotonin in the brain using a chronic dosing regimen of the drug.
Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines
Published in Expert Opinion on Drug Safety, 2018
Laiana A. Quagliato, Rafael C. Freire, Antonio E. Nardi
The authors used the following selection criteria for articles in this review. First, the article had to report on an empirical study in which the pharmacological treatment was applied to a sample of adult subjects diagnosed with PD with or without agoraphobia based on diagnostic criteria recognized by the scientific community. Second, the study had to be an open or placebo-controlled clinical trial. Articles published in English were searched in Medline, PubMed and Web of Science databases, using the following search words: (1). PD or panic attacks and (2). SSRI or citalopram or escitalopram or paroxetine or fluoxetine or fluvoxamine or sertraline, and (3). Benzodiazepines or clonazepam or alprazolam or lorazepam or bromazepam or clobazam or cloxazolam or diazepam. The time period for the literature search was 1997–2017. Articles were excluded if they involved any modality of psychotherapy, medications other than SSRIs and benzodiazepines, studies with no placebo group, and/or included individuals with clinical or psychiatric comorbidities associated with PD. Also, studies with fewer than 10 patients and articles on augmentation treatment or other non-pharmacological treatments such as transcranial magnetic stimulation were excluded. Meeting abstracts, congress proceedings, case reports, reviews, book reviews, corrections, editorials, news items, and reprints were excluded. References cited in the selected papers were also searched manually to ensure that no relevant study on this topic was left out.
Comparing Perika St. John’s Wort and Sertraline for Treatment of Posttraumatic Stress Disorder in Mice
Published in Journal of Dietary Supplements, 2020
Sandra L. McFadden, Brianna L. Hooker
Current treatments for PTSD include various psychological approaches and oral pharmaceuticals, particularly antidepressant medications, either alone or in combination (Sharpless and Barber 2011). There is no standard treatment approach for PTSD as the effectiveness of any treatment depends on the person being treated and the resources available, but trauma-focused psychotherapy (i.e., any therapy that uses cognitive, emotional, or behavioral techniques to facilitate trauma processing) is currently recommended over other psychological and pharmacological approaches as the first-line intervention (U.S. Department of Veterans Affairs 2017). Psychotherapy may not be effective for, or available to, some patients with PTSD, and others may simply prefer medications. In these cases, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (e.g., Paxil) and sertraline (e.g., Zoloft) are considered first-line pharmacological treatments (Reisman 2016; U.S. Department of Veterans Affairs 2017). Numerous studies have found that combining pharmacological (antidepressant) medication with psychotherapy is more effective than either approach alone (Reisman 2016).
Related Knowledge Centers
- Antidepressant
- Anxiety Disorder
- Chemical Synapse
- Major Depressive Disorder
- Reuptake
- Reuptake Inhibitor
- Neurotransmitter
- Serotonin
- Drug Class
- Monoamine Transporter