Fluoxetine anxiety from

Paroxetine. Paroxetine, also a serotonin reuptake inhibitor, has been the subject of a case report in two subjects. Ringold [1994] reported the effective treatment of two individuals who had not responded to prior therapy with fluoxetine and sertraline. Both individuals had comorbid psychiatric problems. Subject A demonstrated both social phobia and dysthymia. Although her symptoms of dysthymia were clinically responsive to fluoxetine therapy, her social phobia symptoms were resistant. Subject B had body dysmorphic disorder, obsessive-compulsive disorder, and social phobia. His obsessive-compulsive disorder symptoms benefited from fluoxetine therapy, but his social anxiety was resistant. Sertraline therapy was attempted in both subjects. Subject A required discontinuation because of adverse effects. Subject B experienced a worsening of both obsessive-compulsive disorder and social phobia symptoms. Both subjects demonstrated a positive response in their symptoms when switched to paroxetine [20 mg/day]. 

As other indications are sought for the SSRls, it is clear that their action extends beyond depression, dysthymia, and the anxiety disorders, and the broad spectrum of therapeutic action of these antidepressants becomes apparent. For example, based on the evidence from placebo-controlled studies [A. Wood 1993], fluoxetine has been licensed in Europe for the treatment of bulimia, and several SSRls are reported to be effective in the treatment of premenstrual syndrome. 

Residential treatment appeared the most likely way of making an impact on Carl s crack cocaine use, and plans were made for an admission. This could not happen immediately, and in the meantime Carl was prescribed fluoxetine 20mg per day, and diazepam 20-30mg per day. He was keen to try to withdraw himself from crack without going into hospital, and he and his mother were instructed about his use of the two medications. They were advised that diazepam would reduce anxiety and agitation, and might help relieve craving for crack. 

Fluoxetine Highly selective blockade of serotonin transporter (SERT) little effect on norepinephrine transporter (NET) Acute increase of serotonergic synaptic activity slower changes in several signaling pathways and neurotrophic activity Major depression, anxiety disorders panic disorder obsessive-compulsive disorder post-traumatic stress disorder perimenopausal vasomotor symptoms eating disorder (bulimia) Half-lives from 15-75 h oral activity Toxicity Well tolerated but cause sexual dysfunction Interactions Some CYP inhibition (fluoxetine 2D6, 3A4 fluvoxamine 1A2 paroxetine 2D6)... 

Martinowich K, Manji H, Bai L. New insights into BDNF function in depression and anxiety. Nature Neurosci. 2007 10 1089-1093. Kolia N, Wei Z, Richardson JS, Li XM. Amitriptyline and fluoxetine protect PC12 cells from cell death induced by hydrogen peroxide. J. Psychiatry Neurosci. 2005 30 196-201. 

Recently, Versiani et al. (1999) conducted a multicenter study involving 157 subjects in whom major depression and comorbid anxiety had been diagnosed. Subjects were randomly assigned to either fluoxetine therapy (20 mg/day) (n = 77) or amitriptyline therapy (50-250 mg/day) (n = 80). Patients were recruited from seven centers in five countries Brazil (n = 52), Mexico (n = 36),... 

Patients treated with paroxetine or sertraline showed improvement in anxiety and avoidance symptoms and a decrease in disability. Daily doses up to 60 mg of paroxetine and 200 mg of sertraline were well tolerated, and emergent adverse effects were similar to those of depression trials (e.g., nausea, sexual dysfunction, sweating, and somnolence). The onset of effect was delayed 4 to 8 weeks, and maximum benefit was often not observed until 12 weeks or longer. Sertraline is also effective in disabled patients suffering from the marked to severe form of generalized SAD. Limited data suggest that citalopram, escitalopram, and fluvoxamine are also effective in treating SAD. Fluoxetine was not effective in SAD. ... 

Nicotine None in usual doses but more depression (2X), impotency, traffic accidents, and more days lost from work Irritability, depressed mood and heart rate, increased appetite, insomnia, anxiety Agonist at Ach receptors, activates dopaminergic pathway (positive reinforcer), speeds and intensifies flow of glutamate Nicotine patch, education, fluoxetine 1 trial success to quit = 9-10% 5-6X for success 24% of population are smokers. Increased use in women, blacks, teenagers and low SES... 

Fluoxetine is absorbed well from the GI tract, is bound to plasma proteins to the extent of 95%, is metabolized in the Uver to norfluoxetine, and is excreted in the urine. Tryptophan is used as an antidepressant. However, the combined use of tryptophan, which increases the level of serotonin, and fluoxetine, which inhibits the neuronal uptake of serotonin, enhances the side effects of fluoxetine such as GI disturbances, anxiety, and insomnia (see Figure 86). 

Interestingly, it appears that fluoxetine is now being successfully used to treat some patients suffering from anxiety. The mechanism of action of this effect is unclear. It could be that an autoreceptor antagonist could mimic this effect or it may be that fluoxetine treatment is causing down regulation of a postsynaptic receptor. Whichever is the case, the possible role(s) of 5-HT,e and 5-HTip receptors in anxiety should also be investigated. 

Corynomycollc acid isolated from the cell walls of Cor-ynebacterium sp. or related organisms exhibit immunostimu-lant properties.Duloxetine is a serotonin-norepinephrine reuptake inhibitor used in major depressive disorder, general anxiety disorder, stress urinary incontinence,diabetic peripheral neuropathy, fibromyalgia,and chronic musculoskeletal pain associated with osteoarthritis and chronic lower back pain. Fluoxetine is a serotonin-uptake inhibitor used as an antidepressant and for treatment of anxiety, alcoholism, and bulimia. " ... 

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