Substance abuse serotonin

Serotonin-boosting antidepressants or longer-acting benzodiazepines are also both suitable first-line treatments for APD. For APD patients who are also troubled by depression, an antidepressant is obviously preferable. We also prefer to use antidepressants rather than benzodiazepines to treat APD patients who have a history of substance abuse. The current data suggests that any of the SSRls as well as nefazodone, mirtazapine, and venlafaxine may be helpful. When these do not work, a MAOI is a reasonable alternative provided the patient is willing to commit to the dietary regimen. 

The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) is widely distributed in the CNS, subsuming a variety of functions including drive satiety, mood, aggression, anxiety, and compulsive and impulsive behaviors. It may be an important neurotransmitter in psychiatric symptoms commonly associated with PTSD such as aggression, obsessive/intrusive thoughts, alcohol and substance abuse, and suicidal behavior (Friedman, 1990). Suicidal behavior is known to be associated with both childhood maltreatment and low 5-HT functioning (Van der Kolk et ah, 1991 Benkelfat,... 

Buspirone tends to be used preferentially in patients with chronic and persistent anxiety, in patients with comorbid substance abuse, and in elderly patients, because it is well tolerated and has no significant pharmacokinetic drug interactions. What is clear is that buspirone shows reproducible efficacy in certain animal models of anxiety and in GAD, which points to a potentially important role of serotonin in mediating anxiety symptoms through 5HT1A receptors. Buspirone also has a role as an augmenting agent for the treatment of resistant depression, as discussed in Chapter 7. 

The selective serotonin reuptake inhibitors or venlafaxine are considered first-line pharmacotherapy for social anxiety disorder, especially in patients with comorbid depression, other anxiety disorders, or substance abuse. 

A 28-year-old woman presents with symptoms of major depression that are unrelated to a general medical condition, bereavement, or substance abuse. She is not currently taking any prescription or over-the-counter medications. Drug treatment is to be initiated with a selective serotonin reuptake inhibitor. In your information to the patient, you would NOT tell her that... 

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