Antidepressants social anxiety disorder

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

The onset of response to antidepressants in social anxiety disorder is delayed and may be as long as 8 to 12 weeks. Patients responding to medication should be continued on treatment for at least 1 year. 

Benzodiazepines. The best studied of the benzodiazepines for social anxiety disorder, clonazepam has been demonstrated in controlled trials to be effective during both acute treatment (at an average dose of 2.4mg/day) and long-term maintenance therapy lasting up to 2 years. A controlled study of another high potency benzodiazepine, alprazolam, also proved effective, though it was outperformed by the MAOI antidepressant phenelzine and exhibited response rates lower than those reported with clonazepam. 

Monoamine Oxidase inhibitors (MAOis). Many, though not all, antidepressants are effective treatments for social anxiety disorder. Although they do not provide rapid symptom relief and may even transiently worsen anxiety symptoms during the first 1-2 weeks of treatment, antidepressants have the advantage of treating comorbid depression. 

Tricyciic Antidepressants (TCAs). There has been surprisingly little study of TCAs in the treatment of social anxiety disorder. Early trials with imipramine and clomipramine suggested they might be beneficial however, subsequent controlled studies indicate that TCAs are no more effective than placebo. Consequently, they are not used to treat social anxiety disorder. 

Serotonin-Boosting Antidepressants. The SSRIs have also been studied in the treatment of generalized social anxiety disorder, and paroxetine, sertraline, and venlafaxine are effective. Preliminary data suggests that the serotonin-boosting atypical antidepressants (mirtazapine and nefazodone) may also be helpful. Like the MAOIs, they appear to be effective at doses comparable to those used to treat depression. They may help avoidant patients to gradually increase their social interaction and become more assertive. 

This group includes compounds with actions on a range of neurotransmitter systems. Their antidepressant efficacy is mediated by reuptake inhibition of serotonin and noradrenaline, although side-effects such as sedation may also be useful. Their use in anxiety disorders is supported by a long history of clinical experience and a reasonable evidence base from controlled trials. Studies support the use of clomipramine (a potent serotonin reuptake inhibitor) in panic disorder and OCD (Lecrubier et al. 1997 Clomipramine Collaborative Study Group 1991), of imipramine in panic disorder and GAD (Cross-National Collaborative Panic Study 1992 Rickels et al. 1993), and of amitriptyline in PTSD (Davidson et al. 1993a). No controlled studies support the use of TCAs in social anxiety disorder. 

In the case of social anxiety disorder, research suggests that some of the antidepressants that are effective in other anxiety disorders do not work to ease the symptoms of social anxiety disorder. This is true of the tricyclic antidepressant imipramine and fluoxetine (Prozac). The first line of treatment for the generalized form of social anxiety disorder is an SSRI such as paroxetine or sertraline. 

In the early 1950s, the MAOI iproniazid was tried to treat tuberculosis. Researchers noticed that even when iproniazid was not effective in treating the tuberculosis, many of their patients seemed to be happier. Soon, iproniazid was put to use to treat depression. Later, MAOIs became the first antidepressants shown to be effective for the treatment of social anxiety disorder, and have since been used in the treatment of all of the anxiety disorders. 

An adequate trial of antidepressants in generalized social anxiety disorder lasts at least 8 weeks, and maximal benefit may not be seen until 1 2 weeks. 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

Sertraline hydrochloride was introduced to the market by Pfizer and known under the brand names Zoloft and Lustral. Sertraline is an antidepressant " " of the selective serotonin reuptake inhibitor (SSRI) class and is primarily used to treat major depression, highly effective for the treatment of panic and social anxiety disorders. ... 

Sertraline hydrochloride (known under the trade names Zoloft and Lustral, both from Pfizer) is an antidepressant chiral drug acting as a selective serotonin reuptake inhibitor (SSRI). It is primarily used in major depression treatment and as obsessive/compulsive, panic, and social anxiety disorders. Ir-Catalyzed enantioselective hydrogenation of C=N bond can be employed to install a second stereogenic... 

Antidepressants are small heterocyclic molecules entering the circulation after oral administration and passing the blood-brain barrier to bind at numerous specific sites in the brain. They are used for treatment of depression, panic disorders, generalized anxiety disorder, social phobia, obsessive compulsive disorder, and other psychiatric disorders and nonpsychiatric states. 

In recent years many of these primary care cases that would formerly have been seen as anxiety disorders have been portrayed as anxious-depressives and have led to treatment with antidepressants, in particular the more recent serotonin reuptake inhibitors. As part of this rebranding a variety of states such as panic disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder have appeared, along with more traditional disorders such as obsessive compulsive disorder (OCD). Many of these diagnoses are likely to lead to prescriptions of an SSRI although the evidence for benefit from SSRIs is poor except for OCD. 

Arguably the first modern class of antidepressants, monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s but are now rarely used in clinical practice because of toxicity and potentially lethal food and drug interactions. Their primary use now is in the treatment of depression unresponsive to other antidepressants. However, MAOIs have also been used historically to treat anxiety states, including social anxiety and panic disorder. In addition, selegiline is used for the treatment of Parkinson s disease (see Chapter 28). 

By the 1990s antidepressants from the serotonin selective reuptake inhibitor (SSRI) class became recognized as preferred first-line treatments for anxiety disorder subtypes, ranging from obsessive-compulsive disorder, to panic disorder, and now to social phobia and posttraumatic stress disorder (Fig. 8—9). Not all antidepressants, however, are afficacious anxiolytics. For example, desipramine and bupropion seem to be of little help in several anxiety disorder subtypes. Documentation of efficacy... 

Antidepressant drugs, however, might have direct anxiolytic effects. That is, certain antidepressants such as paroxetine (Paxil) or venlafaxine (Effexor) can help reduce anxiety independent of their effects on depression.1,47 These antidepressants have therefore been advocated as an alternative treatment for anxiety, especially for people who cannot tolerate the side effects of traditional anxiolytics, or who might be especially susceptible to the addictive properties of drugs like the benzodiazepines.1,9,46 Moreover, antidepressants such as paroxetine or venlafaxine are now considered effective as the primary treatment for several forms of anxiety, including generalized anxiety disorder, social phobia, and panic disorder.4,29,53 Antidepressants, either used alone or in combination with antianxiety drugs, have become an important component in the treatment of anxiety. 

In addition to the treatment of depression, the Food and Drug Administration (FDA) has approved the (on-label) use of the antidepressants for treatment of panic disorders, obsessive-compulsive disorders, bulimia nervosa, social phobia, and generalized anxiety disorder. And although not the treatment of choice, the tricyclics are sometimes used for enuresis—bed wetting. 

Antidepressants may benefit most forms of anxiety disorder, including panic disorder, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and social phobia (see p. 393). 

Social anxiety avoidance Social phobia, panic disorder Antidepressants, beta blockers, benzo diazepines... 

The mood and anxiety disorders in their various permutations constitute a major source of personal suffering and impaired ability to engage in productive Avork and interpersonal relationships. Between 5 and 9% of women and between 2 and 3% of men meet the diagnostic criteria for major depression at any time 10-25% of all women suffer major depression sometime in their lives, while 5-10% of men will develop major depressive disorder (American Psychiatric Association, 1994). The anxiety disorders obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and generalized anxiety disorder (GAD) show lifetime prevalence rates of approximately 2.5%, 7%, 2.5%, and 5% respectively. Between 3 and 13% of individuals in community samples are regarded to meet the diagnostic criteria for social phobia. Mood and anxiety disorders are common comorbidities (American Psychiatric Association, 1994) and the most common antidepressant medications including the serotonin reuptake inhibitors, the mixed serotonin-catecholamine reuptake inhibitors, the tricyclic antidepressants, and the monoamine oxidase inhibitors, are all effective treatments for anxiety and panic attacks. 

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