Anxiolytics sertraline

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD. Sertraline is also effective. Acute response and remission rates are approximately 65% and 30%, respectively. Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs). In one trial, diazepam, trazodone, and imipramine had greater anxiolytic activity than placebo. 

Sussman N. (1998). Anxiolytic antidepressant augmentation. J Clin Psychiatry. 59(suppl 5) 42-48. Tadokoro C, Kiuchi Y, Yamazaki Y, Oguchi K, Kamijima K. (1998). Effects of imipramine and sertraline on protein kinase activity in rat frontal cortex. Eur J Pharmacol. 342(1) 51-4. 

These drugs increase synaptic serotonin by selectively blocking the serotonin reuptake transporter. In preclinical and human studies acute doses tend to be anxiogenic (Bell and Nutt 1998) but chronic administration has anxiolytic effects, possibly due to downregulation of presynaptic autoreceptors (Blier et al. 1990). There are five SSRIs widely available citalopram, fluoxetine, fluvoxam-ine, paroxetine and sertraline. Escitalopram, the S-enantiomer of citalopram. 

May block sigma 1 receptors, enhancing sertraline s anxiolytic actions... 

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