129-423: Selective serotonin reuptake inhibitors ( SSRIs ) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder , anxiety disorders , and other psychological conditions. SSRIs increase the extracellular level of the neurotransmitter serotonin by limiting its reabsorption (reuptake) into the presynaptic cell . They have varying degrees of selectivity for
258-458: A triptan for migraine does not appear to heighten the risk of the serotonin syndrome. Taking monoamine oxidase inhibitors (MAOIs) in combination with SSRIs can be fatal, since MAOIs disrupt monoamine oxidase , an enzyme which is needed to break down serotonin and other neurotransmitters. Without monoamine oxidase, the body is unable to eliminate excess neurotransmitters, allowing them to build up to dangerous levels. The prognosis for recovery in
387-572: A "high risk of bias", but agreed with the EMA assessment that cautionary labeling on SSRIs was warranted. On the 20th of march of 2024, a lawsuit was filed by the organization Public Citizen , representing Dr. Antonei Csoka , against the United States Food and Drug Administration (FDA) for failing to act on a citizen petition submitted in 2018. The petition seeks to have the risk of serious sexual side effects persisting after discontinuation mentioned in
516-831: A 10-week randomized controlled, double-blind trial escitalopram was more effective than placebo. Fluvoxamine , another SSRI, has shown positive results. However, evidence for their effectiveness and acceptability is unclear. Antidepressants are recommended as an alternative or additional first step to self-help programs in the treatment of bulimia nervosa . SSRIs (fluoxetine in particular) are preferred over other anti-depressants due to their acceptability, tolerability, and superior reduction of symptoms in short-term trials. Long-term efficacy remains poorly characterized. Similar recommendations apply to binge eating disorder . SSRIs provide short-term reductions in binge eating behavior, but have not been associated with significant weight loss. Clinical trials have generated mostly negative results for
645-517: A 2004 U.S. Food and Drug Administration (FDA) analysis of clinical trials on children with major depressive disorder found statistically significant increases of the risks of "possible suicidal ideation and suicidal behavior" by about 80%, and of agitation and hostility by about 130%. According to the FDA, the heightened risk of suicidality is within the first one to two months of treatment. The National Institute for Health and Care Excellence (NICE) places
774-498: A 2023 study a possible connection between SSRI usage and the onset of mitral valve regurgitation was identified, indicating that SSRIs could hasten the progression of degenerative mitral valve regurgitation (DMR), especially in individuals carrying 5-HTTLPR genotype. The study’s authors suggest that genotyping should be performed on people with DMR to evaluate serotonin transporter (SERT) activity. They also urge practitioners to exercise caution when prescribing SSRIs to individuals with
903-462: A black box warning for suicidal ideation, but it is generally considered that the risk of suicide in untreated depression is far higher than the risk of suicide when depression is properly treated. Pregabalin (Lyrica) is effective for treating GAD. It acts on the voltage-dependent calcium channel to decrease the release of neurotransmitters such as glutamate, norepinephrine and substance P . Its therapeutic effect appears after 1 week of use and
1032-486: A common molecular mechanism of action modulate the activity of a specific biological target . The definition of a mechanism of action also includes the type of activity at that biological target. For receptors, these activities include agonist , antagonist , inverse agonist , or modulator . Enzyme target mechanisms include activator or inhibitor . Ion channel modulators include opener or blocker . The following are specific examples of drug classes whose definition
1161-418: A comparison of a CAM against a known drug after which no difference in subjects is found by investigators and which is used to suggest an equivalence between a CAM and a drug. Because this equates a lack of evidence with the positive assertion of efficacy, a "lack of difference" assertion is not a proper claim for efficacy. Moreover, an absence of strict definitions and standards for CAM compounds further burdens
1290-413: A daily basis is consistent with clinical observations that the therapeutic effects of SSRIs generally take several weeks to emerge. Sexual dysfunction ranging from decreased libido to anorgasmia is usually considered to be a significantly distressing side effect which may lead to noncompliance in patients receiving SSRIs. However, for those with premature ejaculation, this very same side effect becomes
1419-415: A decrease in bone mineral density, as well as increased fracture risk, a relationship that appears to persist even with adjuvant bisphosphonate therapy. However, because the relationship between SSRIs and fractures is based on observational data as opposed to prospective trials, the phenomenon is not definitively causal. There also appears to be an increase in fracture-inducing falls with SSRI use, suggesting
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#17328582405891548-411: A familial history of DMR. SSRIs directly increase the risk of abnormal bleeding by lowering platelet serotonin levels, which are essential to platelet-driven hemostasis. SSRIs interact with anticoagulants , like warfarin , and antiplatelet drugs , like aspirin . This includes an increased risk of GI bleeding , and post operative bleeding. The relative risk of intracranial bleeding is increased, but
1677-449: A favorable risk-benefit ratio in children with depression, though it was also associated with a slight increase in the risk of self-harm and suicidal ideation. Only two SSRIs are licensed for use with children in the UK, sertraline (Zoloft) and fluvoxamine (Luvox), for the treatment of obsessive–compulsive disorder . Fluoxetine is not licensed for this use. It is unclear whether SSRIs affect
1806-524: A formal diagnosis of GAD. Individuals with GAD often have other disorders including other psychiatric disorders (e.g., major depressive disorder ), substance use disorder, obesity, and may have a history of trauma or family with GAD. Clinicians use screening tools such as the GAD-7 and GAD-2 questionnaires to determine if individuals may have GAD and warrant formal evaluation for the disorder. Additionally, sometimes screening tools may enable clinicians to evaluate
1935-629: A greater number of minor stress-related events in life and that the number of stress-related events may be important in development of GAD (irrespective of other individual characteristics). Studies of possible genetic contributions to the development of GAD have examined relationships between genes implicated in brain structures involved in identifying potential threats (e.g., in the amygdala ) and also implicated in neurotransmitters and neurotransmitter receptors known to be involved in anxiety disorders. More specifically, genes studied for their relationship to development of GAD or demonstrated to have had
2064-446: A hereditary basis for GAD, but the exact nature of this hereditary basis is not fully understood. While investigators have identified several genetic loci that are regions of interest for further study, there is no singular gene or set of genes that have been identified as causing GAD. Nevertheless, genetic factors may play a role in determining whether an individual is at greater risk for developing GAD, structural changes in
2193-475: A hierarchy. For example, fibrates are a chemical class of drugs (amphipathic carboxylic acids) that share the same mechanism of action ( PPAR agonist ), the same mode of action (reducing blood triglyceride levels), and are used to prevent and treat the same disease ( atherosclerosis ). However, not all PPAR agonists are fibrates, not all triglyceride-lowering agents are PPAR agonists, and not all drugs used to treat atherosclerosis lower triglycerides. A drug class
2322-424: A hospital setting is generally good if serotonin syndrome is correctly identified. Treatment consists of discontinuing any serotonergic drugs and providing supportive care to manage agitation and hyperthermia , usually with benzodiazepines . Meta analyses of short duration randomized clinical trials have found that SSRI use is related to a higher risk of suicidal behavior in children and adolescents. For instance,
2451-423: A low potential for misuse and dependency and may be preferred over the benzodiazepines for these reasons. The anxiolytic effects of pregabalin appear to persist for at least six months continuous use, suggesting tolerance is less of a concern; this gives pregabalin an advantage over certain anxiolytic medications such as benzodiazepines. Gabapentin (Neurontin), a closely related medication to pregabalin with
2580-585: A lower risk of withdrawal compared to SNRIs. If sertraline is found to be ineffective, then it is recommended to try another SSRI or SNRI. Common side effects include nausea , sexual dysfunction , headache , diarrhea , constipation , restlessness , increased risk of suicide in young adults and adolescents, among others . Sexual side effects, weight gain, and higher risk of withdrawal are more common in paroxetine than escitalopram and sertraline. In older populations or those taking concomitant medications that increase risk of bleeding, SSRIs may further increase
2709-510: A mainstay in treating GAD in adults. First-line medications from any drug category often include those that have been approved by the Food and Drug Administration (FDA) or other similar regulatory body such as the EMA or TGA for treating GAD because these drugs have been shown to be safe and effective. FDA-approved medications for treating GAD include: While certain medications are not specifically FDA approved for treatment of GAD, there are
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#17328582405892838-504: A meta-analysis of 39 studies comprising 21,736 subjects that found a small-to-medium association between smartphone use and anxiety. In December 2018, Frontiers in Psychiatry published a systematic review of 9 studies published after 2014 investigating associations between problematic social networking sites (SNS) use and comorbid psychiatric disorders that found a positive association between problematic SNS use and anxiety. In March 2019,
2967-577: A number of medications that historically have been used or studied for treating GAD. Other medications that have been used or evaluated for treating GAD include: Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs). SSRIs increase serotonin levels through inhibition of serotonin reuptake receptors. FDA approved SSRIs used for this purpose include escitalopram and paroxetine . However, guidelines suggest using sertraline first due to its cost-effectiveness compared to other SSRIs used for generalized anxiety disorder and
3096-458: A real-life situation), which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli. Exposure is used to promote fear tolerance. Exposure therapy is also a preferred method for children who struggle with anxiety. Medications that have been studied were reviewed in
3225-798: A recent network meta-analysis that compared all studied medications with placebo and also with each other and another compared the rates of remission between different medications. Benzodiazepines (BZs) have been used to treat anxiety starting in the 1960s. There is a risk of dependence and tolerance to benzodiazepines. BZs have a number of effects that make them a good option for treating anxiety including anxiolytic, hypnotic (induce sleep), myorelaxant (relax muscles), anticonvulsant, and amnestic (impair short-term memory) properties. While BZs work well to alleviate anxiety shortly after administration, they are also known for their ability to promote dependence and are frequently used recreationally or non-medically. Antidepressants (e.g., SSRIs / SNRIs ) have become
3354-448: A reduction or loss of sensitivity in the genitals or other erogenous zones . Additional non-sexual symptoms are also commonly described, including emotional numbing , anhedonia , depersonalization or derealization , and cognitive impairment . The duration of PSSD symptoms appears to vary among patients, with some cases resolving in months and others in years or decades; one analysis of patient reports submitted between 1992 and 2021 in
3483-497: A relationship to treatment response include: In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found a 92% correlation between IGD and anxiety and a 75% correlation between IGD and social anxiety. In August 2018, Wiley Stress & Health published
3612-664: A set of symptoms reported by some people who have taken SSRIs or other serotonin reuptake-inhibiting (SRI) drugs, in which sexual dysfunction symptoms persist for at least three months after ceasing to take the drug. The status of PSSD as a legitimate and distinct pathology is contentious; several researchers have proposed that it should be recognized as a separate phenomenon from more common SSRI side effects. The reported symptoms of PSSD include reduced sexual desire or arousal , erectile dysfunction in males or loss of vaginal lubrication in females, difficulty having an orgasm or loss of pleasurable sensation associated with orgasm, and
3741-423: A significant positive association between social anxiety and mobile phone addiction. In August 2022, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and anxiety. In November 2022, Cyberpsychology, Behavior, and Social Networking published
3870-466: A small and unimportant way compared with placebo." However, it also noted significant methodological limitations that make drawing definitive conclusions about efficacy difficult. Fluoxetine is the only SSRI authorized for use in children and adolescents with moderate to severe depression in the United Kingdom . Some SSRIs are effective for social anxiety disorder, although their effects on symptoms
3999-508: A small but positive association between social media use and anxiety, while JMIR Mental Health published a systematic review and meta-analysis of 18 studies comprising 9,269 adolescent and young adult subjects that found a moderate but statistically significant association between problematic social media use and anxiety. In May 2022, Computers in Human Behavior published a meta-analysis of 82 studies comprising 48,880 subjects that found
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4128-410: A statistically significant correlation between cybervictimization and anxiety with a moderate-to-large effect size. In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and anxiety in children, while Adolescent Psychiatry published
4257-686: A systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and anxiety and positive associations between higher levels of problematic smartphone use and elevated risk of anxiety, while Frontiers in Psychology published a systematic review of 10 studies of adolescent or young adult subjects in China that concluded that the research reviewed mostly established an association between social networks use disorder and anxiety among Chinese adolescents and young adults. In April 2020, BMC Public Health published
4386-428: A systematic review and meta-analysis of 16 studies that established correlation coefficients of 0.31 and 0.39 between nomophobia and anxiety and nomophobia and smartphone addiction respectively. The pathophysiology of GAD is an active and ongoing area of research often involving the intersection of genetics and neurological structures. Generalized anxiety disorder has been linked to changes in functional connectivity of
4515-705: A systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and anxiety. In November 2020, Child and Adolescent Mental Health published a systematic review of research published between January 2005 and March 2019 on associations between SNS use and anxiety symptoms in subjects between ages of 5 to 18 years that found that increased SNS screen time or frequency of SNS use and higher levels of investment (i.e. personal information added to SNS accounts) were significantly associated with higher levels of anxiety symptoms. In January 2021, Frontiers in Psychiatry published
4644-471: A systematic review of 1,747 articles on problematic social media use that found a strong bidirectional relationship between social media use and anxiety. In March 2023, the Journal of Public Health published a meta-analysis of 27 studies published after 2014 comprising 120,895 subjects that found a moderate and robust association between problematic smartphone use and anxiety. In July 2023, Healthcare published
4773-714: A systematic review of 44 studies investigating social media use and development of psychiatric disorders in childhood and adolescence that concluded that the research reviewed established a direct association between levels of anxiety, social media addiction behaviors, and nomophobia, longitudinal associations between social media use and increased anxiety, that fear of missing out and nomophobia are associated with severity of Facebook usage, and suggested that fear of missing out may trigger social media addiction and that nomophobia appears to mediate social media addiction. In March 2021, Computers in Human Behavior Reports published
4902-511: A systematic review of 52 studies published before May 2020 that found that social anxiety was associated with problematic social media use and that socially anxious persons used social media to seek social support possibly to compensate for a lack of offline social support. In June 2021, Clinical Psychology Review published a systematic review of 35 longitudinal studies published before August 2020 that found that evidence for longitudinal associations between screen time and anxiety among young people
5031-458: A systematic review of 70 cross-sectional and longitudinal studies investigating moderating factors for associations for screen-based sedentary behaviors and anxiety symptoms among youth that found that while screen types was the most consistent factor, the body of evidence for anxiety symptoms was more limited than for depression symptoms. In October 2020, the Journal of Behavioral Addictions published
5160-518: A systematic review of research published from June 2010 through June 2020 studying associations between social media use and anxiety among adolescent subjects aged 13 to 18 years that established that 78.3% of studies reviewed reported positive associations between social media use and anxiety. In April 2022, researchers in the Department of Communication at Stanford University performed a meta-analysis of 226 studies comprising 275,728 subjects that found
5289-457: Is major depressive disorder ; however, they are frequently prescribed for anxiety disorders , such as social anxiety disorder , generalized anxiety disorder , panic disorder , obsessive–compulsive disorder (OCD), eating disorders , chronic pain , and, in some cases, for posttraumatic stress disorder (PTSD). They are also frequently used to treat depersonalization disorder , although with varying results. Antidepressants are recommended by
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5418-420: Is a behavioral treatment based on acceptance-based models. ACT is designed with the purpose to target three therapeutic goals: (1) reduce the use of avoiding strategies intended to avoid feelings, thoughts, memories, and sensations; (2) decreasing a person's literal response to their thoughts (e.g., understanding that thinking "I'm hopeless" does not mean that the person's life is truly hopeless), and (3) increasing
5547-470: Is a common disorder of which the central feature is excessive worry about a number of different events. Key symptoms include excessive anxiety about multiple events and issues, and difficulty controlling worrisome thoughts, that persists for at least 6 months. Antidepressants provide a modest-to-moderate reduction in anxiety in GAD, and are superior to placebo in treating GAD. The efficacy of different antidepressants
5676-504: Is a short-term psychotherapy that is focused on humanistic needs of emotions when treating individuals with GAD. EFT can incorporate numerous practices such as experimental therapy, systemic therapy, and elements of CBT to allow individuals to work through difficult emotional states. The primary goal of EFT is assisting individuals in living with their vulnerable emotions and overcoming avoidance so that adaptive experiences such as compassion and protective anger can be generated in response to
5805-450: Is a summary of academic findings. Accordingly, none of the following should be taken as offering medical guidance or an opinion as to the safety or efficacy of any of the following modalities . Lifestyle factors including: stress management , stress reduction, relaxation, sleep hygiene , and caffeine and alcohol reduction can influence anxiety levels. Physical activity has shown to have a positive impact whereas low physical activity may be
5934-536: Is a type of therapy premised upon Freudian psychology in which a psychologist enables an individual explore various elements in their subconscious mind to resolve conflicts that may exist between the conscious and subconscious elements of the mind. In the context of GAD, the psychodynamic theory of anxiety suggests that the unconscious mind engages in worry as a defense mechanism to avoid feelings of anger or hostility because such feelings might cause social isolation or other negative attribution toward oneself. Accordingly,
6063-621: Is also associated with preterm birth . According to some researches, decreased body weight of the child, intrauterine growth retardation, neonatal adaptive syndrome, and persistent pulmonary hypertension also was noted. A systematic review of the risk of major birth defects in antidepressant-exposed pregnancies found a small increase (3% to 24%) in the risk of major malformations and a risk of cardiovascular birth defects that did not differ from non-exposed pregnancies. Other studies have found an increased risk of cardiovascular birth defects among depressed mothers not undergoing SSRI treatment, suggesting
6192-455: Is also used. The positive effects (if any) of complementary and alternative medications (CAMs), exercise, therapeutic massage and other interventions have been studied. Estimates regarding prevalence of GAD or lifetime risk (i.e., lifetime morbid risk [LMR]) for GAD vary depending upon which criteria are used for diagnosing GAD (e.g., DSM-5 versus ICD-10 ) although estimates do not vary widely between diagnostic criteria. In general, ICD-10
6321-399: Is available to determine whether there are long-term effects. Persistent pulmonary hypertension (PPHN) is a serious and life-threatening, but very rare, lung condition that occurs soon after birth of the newborn. Newborn babies with PPHN have high pressure in their lung blood vessels and are not able to get enough oxygen into their bloodstream. About 1 to 2 babies per 1000 babies born in
6450-410: Is based on a specific mechanism of action: This type of categorisation of drugs is from a biological perspective and categorises them by the anatomical or functional change they induce. Drug classes that are defined by common modes of action (i.e. the functional or anatomical change they induce) include: This type of categorisation of drugs is from a medical perspective and categorises them by
6579-425: Is based on asking open-ended questions and listening carefully and reflectively to patients' answers, eliciting "change talk", and talking with patients about the pros and cons of change. Some studies have shown the combination of CBT with MI to be more effective than CBT alone. Cognitive behavioral therapy (CBT) is an evidence-based type of psychotherapy that demonstrates efficacy in treating GAD and which integrates
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#17328582405896708-618: Is considered among all anxiety disorders (e.g., panic disorder, social anxiety disorder), genetic studies suggest that hereditary contribution to the development of anxiety disorders amounts to only approximately 30–40%, which suggests that environmental factors are likely more important to determining whether an individual may develop GAD. In regard to environmental influences in the development of GAD, it has been suggested that parenting behaviour may be an important influence since parents potentially model anxiety-related behaviours. It has also been suggested that individuals with GAD have experienced
6837-456: Is effective. The mechanism by which SRIs may induce PSSD is unclear; neurobiological and cognitive factors may act in combination to cause the problem. As of 2023, prevalence is unknown. A 2020 review stated that PSSD is rare, underreported, and "increasingly identified in online communities". A 2024 study investigating the prevalence of persistent post-treatment genital numbness among sexual and gender minority youth found 13.2% of SSRI users between
6966-427: Is frequently prescribed off-label to treat GAD. Complementary and alternative medicines (CAMs) are widely used by individuals with GAD despite having no evidence or varied evidence regarding efficacy. Efficacy trials for CAM medications often have various types of bias and low quality reporting in regard to safety. In regard to efficacy, critics point out that CAM trials sometimes predicate claims of efficacy based on
7095-476: Is generally seen as the most desirable approach to treatment. Use of medication to lower extreme anxiety levels can be important in enabling patients to engage effectively in CBT. Psychotherapeutic interventions include a plurality of therapy types that vary based upon their specific methodologies for enabling individuals to gain insight into the working of the conscious and subconscious mind and which sometimes focus on
7224-447: Is independently associated with negative pregnancy outcomes, determining the extent to which observed associations between antidepressant use and specific adverse outcomes reflects a causative relationship has been difficult in some cases. In other cases, the attribution of adverse outcomes to antidepressant exposure seems fairly clear. SSRI use in pregnancy is associated with an increased risk of spontaneous abortion of about 1.7-fold. Use
7353-542: Is more inclusive than DSM-5, so estimates regarding prevalence and lifetime risk tend to be greater using ICD-10. In regard to prevalence, in a given year, about two (2%) percent of adults in the United States and Europe have been suggested to have GAD. However, the risk of developing GAD at any point in life has been estimated at 9.0%. Although it is possible to experience a single episode of GAD during one's life, most people who experience GAD experience it repeatedly over
7482-620: Is more sensitive than an amygdala in an individual without GAD or whether frontal cortex hyperactivity is responsible for changes in amygdala responsiveness to various stimuli. Recent studies have attempted to identify specific regions of the frontal cortex (e.g., dorsomedial prefrontal cortex [dmPFC]) that may be more or less reactive in individuals who have GAD or specific networks that may be differentially implicated in individuals who have GAD. Other lines of study investigate whether activation patterns vary in individuals who have GAD at different ages with respect to individuals who do not have GAD at
7611-422: Is no agreement on standards for diagnosis. It is considered a distinct phenomenon from antidepressant discontinuation syndrome , post-acute withdrawal syndrome , and major depressive disorder , and should be distinguished from sexual dysfunction associated with depression and persistent genital arousal disorder . There are limited treatment options for PSSD as of 2023 and no evidence that any individual approach
7740-503: Is not always robust and their use is sometimes rejected in favor of psychological therapies. Paroxetine was the first drug to be approved for social anxiety disorder and it is considered effective for this disorder; sertraline and fluvoxamine were later approved for it as well. Escitalopram and citalopram are used off-label with acceptable efficacy, while fluoxetine is not considered to be effective for this disorder. The effect sizes ( Cohen's d ) of SSRIs in terms of improvement on
7869-438: Is one of the most common reasons people stop the medication. The mechanism by which SSRIs may cause sexual side effects is not well understood as of 2021. The range of possible mechanisms includes (1) nonspecific neurological effects (e.g., sedation) that globally impair behavior including sexual function; (2) specific effects on brain systems mediating sexual function; (3) specific effects on peripheral tissues and organs, such as
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#17328582405897998-409: Is only approximately 30–40%, which suggests that environmental factors may be more important to determining whether an individual develops GAD. There is a strong overlapping relationship between GAD and major depressive disorder (MDD), with 72% of those with a lifelong diagnosis of GAD also being diagnosed with MDD at some point in their lives. The pathophysiology of GAD implicates several regions of
8127-677: Is premised upon the idea that anxiety is the result of maladaptive beliefs and methods of thinking. Thus, CT involves assisting individuals to identify more rational ways of thinking and to replace maladaptive thinking patterns (i.e., cognitive distortions) with healthier thinking patterns (e.g., replacing the cognitive distortion of catastrophizing with a more productive pattern of thinking). Individuals in CT learn how to identify objective evidence, test hypotheses, and ultimately identify maladaptive thinking patterns so that these patterns can be challenged and replaced. Acceptance and commitment therapy (ACT)
8256-458: Is similar in effectiveness to lorazepam , alprazolam and venlafaxine but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychic and somatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance and additionally, unlike benzodiazepines, it does not disrupt sleep architecture and produces less severe cognitive and psychomotor impairment. It also has
8385-521: Is similar. In Canada, SSRIs are a first-line treatment of adult obsessive–compulsive disorder (OCD). In the UK, they are first-line treatment only with moderate to severe functional impairment and as second line treatment for those with mild impairment, though, as of early 2019, this recommendation is being reviewed. In children, SSRIs can be considered a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects. SSRIs, especially fluvoxamine , which
8514-471: Is strong evidence of a hereditary basis for GAD in that GAD is more likely to occur in first-degree relatives of individuals who have GAD than in non-related individuals in the same population. Twin studies also suggest that there may be a genetic linkage between GAD and major depressive disorder (MDD), which may explain the common occurrence of MDD in individuals who have GAD (e.g., comorbidity of MDD in individuals with GAD has been estimated at 60% ). When GAD
8643-406: Is the first one to be FDA approved for OCD, are efficacious in its treatment; patients treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been demonstrated both in short-term treatment trials of 6 to 24 weeks and in discontinuation trials of 28 to 52 weeks duration. Paroxetine CR was superior to placebo on the primary outcome measure. In
8772-527: Is thus composed by one element ("anti-inflammatory") that designates the mechanism of action, and one element ("nonsteroidal") that separates it from other drugs with that same mechanism of action. Similarly, one might argue that the class of disease-modifying anti-rheumatic drugs (DMARD) is composed by one element ("disease-modifying") that albeit vaguely designates a mechanism of action, and one element ("anti-rheumatic drug") that indicates its therapeutic use. Other systems of drug classification exist, for example
8901-404: Is typically caused by the use of two or more serotonergic drugs, including SSRIs. Serotonin syndrome is a condition that can range from mild (most common) to deadly. Mild symptoms may consist of increased heart rate , fever , shivering, sweating , dilated pupils , myoclonus (intermittent jerking or twitching), as well as hyperreflexia . Concomitant use of SSRIs or SNRIs for depression with
9030-493: Is typically defined by a prototype drug , the most important, and typically the first developed drug within the class, used as a reference for comparison. This type of categorisation of drugs is from a chemical perspective and categorises them by their chemical structure. Examples of drug classes that are based on chemical structures include: This type of categorisation is from a pharmacological perspective and categorises them by their biological target. Drug classes that share
9159-469: Is used as a stand-alone treatment for GAD patients. Thus, IUT focuses on helping patients in developing the ability to tolerate, cope with and accept uncertainty in their life in order to reduce anxiety. IUT is based on the psychological components of psychoeducation, awareness of worry, problem-solving training, re-evaluation of the usefulness of worry, imagining virtual exposure, recognition of uncertainty, and behavioral exposure. Studies have shown support for
9288-609: Is used off-label, but with mixed results; venlafaxine, an SNRI, is considered somewhat effective, although its use is also off-label. Fluvoxamine, escitalopram and citalopram are not well tested in this disorder. Paroxetine remains the most suitable drug for PTSD as of now, but with limited benefits. SSRIs are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of generalized anxiety disorder (GAD) that has failed to respond to conservative measures such as education and self-help activities. GAD
9417-878: The Biopharmaceutics Classification System which determines a drugs' attributes by solubility and intestinal permeability. Generalized anxiety disorder Generalized anxiety disorder ( GAD ) is a mental and behavioral disorder , specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping , exhaustion, irritability, sweating, and trembling . Symptoms must be consistent and ongoing, persisting at least six months, for
9546-564: The DSM-III in 1980, when anxiety neurosis was split into GAD and panic disorder . The definition in the DSM-III required uncontrollable and diffuse anxiety or worry that is excessive and unrealistic and persists for 1 month or longer. High rates in comorbidity of GAD and major depression led many commentators to suggest that GAD would be better conceptualized as an aspect of major depression instead of an independent disorder. Many critics stated that
9675-400: The International Journal of Adolescence and Youth published a systematic review of 13 studies comprising 21,231 adolescent subjects aged 13 to 18 years that found that social media screen time, both active and passive social media use, the amount of personal information uploaded, and social media addictive behaviors all correlated with anxiety. In February 2020, Psychiatry Research published
9804-580: The Liebowitz social anxiety scale in individual published trials of the drugs for social anxiety disorder have ranged from –0.029 to 1.214. PTSD is relatively hard to treat and generally treatment is not highly effective; SSRIs are no exception. They are not very effective for this disorder and only two SSRI are FDA approved for this condition: paroxetine and sertraline. Paroxetine has slightly higher response and remission rates for PTSD than sertraline, but both are not fully effective for many patients. Fluoxetine
9933-494: The Netherlands listed a case which had reportedly persisted for 23 years. The symptoms of PSSD are largely shared with post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD) , two other poorly-understood conditions which have been suggested to share a common etiology with PSSD despite being associated with different types of medication. Diagnostic criteria for PSSD were proposed in 2022, but as of 2023, there
10062-534: The amygdala and its processing of fear and anxiety. Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal and accessory basal nuclei). The basolateral complex processes the sensory-related fear memories and communicates information regarding threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices. Neurological structures traditionally appreciated for their roles in anxiety include
10191-579: The EMA assessment, a safety review by Health Canada "could neither confirm nor rule out a causal link ... which was long lasting in rare cases", but recommended that "healthcare professionals inform patients about the potential risk of long-lasting sexual dysfunction despite discontinuation of treatment". A 2023 review stated that ongoing sexual dysfunction after SSRI discontinuation was possible, but that cause and effect were undetermined. The 2023 review cautioned that reports of sexual dysfunction cannot be generalized to wider practice as they are subject to
10320-537: The International Statistical Classification of Disease (ICD-10) provides a different set of diagnostic criteria for GAD than the DSM-5 criteria described above. In particular, ICD-10 allows diagnosis of GAD as follows: See ICD-10 F41.1 Note: For children different ICD-10 criteria may be applied for diagnosing GAD (see F93.80). The American Psychiatric Association introduced GAD as a diagnosis in
10449-766: The SNRIs have a higher prevalence of the side effects of insomnia, dry mouth, nausea and high blood pressure. Both SNRIs have the potential for discontinuation syndrome after abrupt cessation, which can precipitate symptoms including motor disturbances and anxiety and may require tapering. Like other serotonergic agents, SNRIs have the potential to cause serotonin syndrome, a potentially fatal systemic response to serotonergic excess that causes symptoms including agitation, restlessness, confusion, tachycardia, hypertension, mydriasis, ataxia, myoclonus, muscle rigidity, diaphoresis, diarrhea, headache, shivering, goose bumps, high fever, seizures, arrhythmia and unconsciousness. SNRIs like SSRIs carry
10578-559: The U.S. develop PPHN shortly after birth, and often they need intensive medical care . It is associated with about a 25% risk of significant long-term neurological deficits. A 2014 meta analysis found no increased risk of persistent pulmonary hypertension associated with exposure to SSRI's in early pregnancy and a slight increase in risk associates with exposure late in pregnancy; "an estimated 286 to 351 women would need to be treated with an SSRI in late pregnancy to result in an average of one additional case of persistent pulmonary hypertension of
10707-710: The UK National Institute for Health and Care Excellence (NICE) as a first-line treatment of severe depression and for the treatment of mild-to-moderate depression that persists after conservative measures such as cognitive therapy . They recommend against their routine use by those who have chronic health problems and mild depression. There has been controversy regarding the efficacy of SSRIs in treating depression depending on its severity and duration. The use of SSRIs in children with depression remains controversial. A 2021 Cochrane review concluded that, for children and adolescents, SSRIs "may reduce depression symptoms in
10836-461: The absolute risk is very low. SSRIs are known to cause platelet dysfunction. This risk is greater in those who are also on anticoagulants, antiplatelet agents and NSAIDs (nonsteroidal anti-inflammatory drugs), as well as with the co-existence of underlying diseases such as cirrhosis of the liver or liver failure. Evidence from longitudinal, cross-sectional, and prospective cohort studies suggests an association between SSRI usage at therapeutic doses and
10965-606: The ages 15 and 29 reporting the symptom compared to 0.9% who had used other medications. Reports of PSSD have occurred with almost every SSRI ( dapoxetine is an exception). In 2019, the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency (EMA) recommended that packaging leaflets of selected SSRIs and SNRIs should be amended to include information regarding a possible risk of persistent sexual dysfunction. Following
11094-471: The amygdala, insula and orbitofrontal cortex (OFC). It is broadly postulated that changes in one or more of these neurological structures are believed to allow greater amygdala response to emotional stimuli in individuals who have GAD as compared to individuals who do not have GAD. Individuals with GAD have been suggested to have greater amygdala and medial prefrontal cortex (mPFC) activation in response to stimuli than individuals who do not have GAD. However,
11223-623: The brain related to GAD, or whether an individual is more or less likely to respond to a particular treatment modality. Genetic factors that may play a role in development of GAD are usually discussed in view of environmental factors (e.g., life experience or ongoing stress) that might also play a role in development of GAD. The traditional methods of investigating the possible hereditary basis of GAD include using family studies and twin studies (there are no known adoption studies of individuals who have anxiety disorders, including GAD). Meta-analysis of family and twin studies suggests that there
11352-428: The brain that mediate the processing of stimuli associated with fear, anxiety, memory, and emotion (i.e., the amygdala , insula , and the frontal cortex ). The amygdala is part of the brain that is associated with experiencing emotions. In the amygdala, the basolateral amygdala complex recognizes sensory information and activates GABAergic neurons which can cause somatic symptoms of anxiety. GABAergic neurons control
11481-791: The cognitive and behavioral therapeutic approaches. The objective of CBT is to enable individuals to identify irrational thoughts that cause anxiety and to challenge dysfunctional thinking patterns by engaging in awareness techniques such as hypothesis testing and journaling. Because CBT involves the practice of worry and anxiety management, CBT includes a plurality of intervention techniques that enable individuals to explore worry, anxiety and automatic negative thinking patterns. These interventions include anxiety management training, cognitive restructuring, progressive relaxation, situational exposure and self-controlled desensitization. Several modes of delivery are effective in treating GAD, including internet-delivered CBT, or iCBT. Emotion-focused therapy (EFT)
11610-527: The concept that anxiety is learned through classical conditioning (e.g., in view of one or more negative experiences) and maintained through operant conditioning (e.g., one finds that by avoiding a feared experience that one avoids anxiety). Thus, behavioral therapy enables an individual to re-learn conditioned responses (behaviors) and to thereby challenge behaviors that have become conditioned responses to fear and anxiety, and which have previously given rise to further maladaptive behaviors. Cognitive therapy (CT)
11739-660: The course of their lives as a chronic or ongoing condition. GAD is diagnosed twice as frequently in women as in men. The diagnostic criteria for GAD as defined by the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (2013), published by the American Psychiatric Association , are paraphrased as follows: No major changes to GAD have occurred since publication of the Diagnostic and Statistical Manual of Mental Disorders (2004); minor changes include wording of diagnostic criteria. The 10th revision of
11868-445: The desired effect . SSRIs such as sertraline have been found to be effective in decreasing anger . Side effects vary among the individual drugs of this class. They may include akathisia . SSRIs can cause various types of sexual dysfunction such as anorgasmia , erectile dysfunction , diminished libido , genital numbness, and sexual anhedonia (pleasureless orgasm). Sexual problems are common with SSRIs. Poor sexual function
11997-537: The diagnosis the DSM-IV clarified was what constitutes a symptom as occurring "often". The DSM-IV also required difficulty controlling the worry to be diagnosed with GAD. The DSM-5 emphasized that excessive worrying had to occur more days than not and on a number of different topics. It has been stated that the constant changes in the diagnostic features of the disorder have made assessing epidemiological statistics such as prevalence and incidence difficult, as well as increasing
12126-453: The diagnostic features of this disorder were not well established until the DSM-III-R. Since comorbidity of GAD and other disorders decreased with time, the DSM-III-R changed the time requirement for a GAD diagnosis to 6 months or longer. The DSM-IV changed the definition of excessive worry and the number of associated psychophysiological symptoms required for a diagnosis. Another aspect of
12255-410: The difficulty for researchers in identifying the biological and psychological underpinnings of the disorder. Consequently, making specialized medications for the disorder is more difficult as well. This has led to the continuation of GAD being medicated heavily with SSRIs. The relationship between genetics and anxiety disorders is an ongoing area of research. It is broadly understood that there exists
12384-677: The efficacy of this therapy with GAD patients with continued improvements in follow-up periods. A promising innovative approach to improving recovery rates for the treatment of GAD is to combine CBT with motivational interviewing (MI). Motivational interviewing is a strategy centered on the patient that aims to increase intrinsic motivation and decrease ambivalence about change due to the treatment. MI contains four key elements: (1) express empathy, (2) heighten dissonance between behaviors that are not desired and values that are not consistent with those behaviors, (3) move with resistance rather than direct confrontation, and (4) encourage self-efficacy . It
12513-442: The emotional needs that are embedded in core emotional vulnerability. Sandplay therapy (SPT) is an intervention based on nonverbal therapeutic practices. The main objective of SPT is to allow the individual the ability to work through their emotional problems from childhood traumas (CT) through play using sand and toy figures. Although the therapy is mainly focused on nonverbal cues, verbal cues are also observed and documented during
12642-490: The exact relationship between the amygdala and the frontal cortex (e.g., prefrontal cortex or the orbitofrontal cortex [OFC]) is not fully understood because there are studies that suggest increased or decreased activity in the frontal cortex in individuals who have GAD. Consequently, because of the tenuous understanding of the frontal cortex as it relates to the amygdala in individuals who have GAD, it's an open question as to whether individuals who have GAD bear an amygdala that
12771-700: The excess risk in the "early stages of treatment". The European Psychiatric Association places the excess risk in the first two weeks of treatment and, based on a combination of epidemiological, prospective cohort, medical claims, and randomized clinical trial data, concludes that a protective effect dominates after this early period. A 2014 Cochrane review found that at six to nine months, suicidal ideation remained higher in children treated with antidepressants compared to those treated with psychological therapy. A recent comparison of aggression and hostility occurring during treatment with fluoxetine to placebo in children and adolescents found that no significant difference between
12900-475: The fluoxetine group and a placebo group. There is also evidence that higher rates of SSRI prescriptions are associated with lower rates of suicide in children, though since the evidence is correlational , the true nature of the relationship is unclear. In 2004, the Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom judged fluoxetine (Prozac) to be the only antidepressant that offered
13029-540: The literature regarding CAM efficacy in treating GAD. CAMs academically studied for their potential in treating GAD or GAD symptoms along with a summary of academic findings are given below. What follows is a summary of academic findings. Accordingly, none of the following should be taken as offering medical guidance or an opinion as to the safety or efficacy of any of the following CAMs. Other modalities that have been academically studied for their potential in treating GAD or symptoms of GAD are summarised below. What follows
13158-420: The medication, or switching to a different antidepressant that may have less propensity for causing this side effect. Acute narrow-angle glaucoma is the most common and important ocular side effect of SSRIs, and often goes misdiagnosed. SSRIs do not appear to affect the risk of coronary heart disease (CHD) in those without a previous diagnosis of CHD. A large cohort study suggested no substantial increase in
13287-399: The need for increased attention to fall risk in elderly patients using the medication. The loss of bone density does not appear to occur in younger patients taking SSRIs. SSRI and SNRI antidepressants may cause jaw pain/jaw spasm reversible syndrome (although it is not common). Buspirone appears to be successful in treating bruxism on SSRI/SNRI induced jaw clenching. Serotonin syndrome
13416-400: The nervous system by reducing feelings of stress, anxiety, and fear. When there is an inadequate number of GABAergic neurons, those negative feelings become apparent and can release somatic responses of stress. It has been suggested that individuals with GAD have greater amygdala and medial prefrontal cortex (mPFC) activity in response to stimuli than individuals who do not have GAD. However,
13545-701: The newborn". A review published in 2012 reached conclusions very similar to those of the 2014 study. Class of drugs A drug class is a group of medications and other compounds that share similar chemical structures , act through the same mechanism of action (i.e., binding to the same biological target ), have similar modes of action , and/or are used to treat similar diseases. The FDA has long worked to classify and license new medications. Its Drug Evaluation and Research Center categorizes these medications based on both their chemical and therapeutic classes. In several major drug classification systems, these four types of classifications are organized into
13674-478: The other monoamine transporters , with pure SSRIs having strong affinity for the serotonin transporter and only weak affinity for the norepinephrine and dopamine transporters . SSRIs are the most widely prescribed antidepressants in many countries especially the world. The efficacy of SSRIs in mild or moderate cases of depression has been disputed and may or may not be outweighed by side effects, especially in adolescent populations. The main indication for SSRIs
13803-487: The pathology they are used to treat. Drug classes that are defined by their therapeutic use (the pathology they are intended to treat) include: Some drug classes have been amalgamated from these three principles to meet practical needs. The class of nonsteroidal anti-inflammatory drugs (NSAIDs) is one such example. Strictly speaking, and also historically, the wider class of anti-inflammatory drugs also comprises steroidal anti-inflammatory drugs . These drugs were in fact
13932-442: The penis, that mediate sexual function; and (4) direct or indirect effects on hormones mediating sexual function. Management strategies include: for erectile dysfunction the addition of a PDE5 inhibitor such as sildenafil ; for decreased libido, possibly adding or switching to bupropion ; and for overall sexual dysfunction, switching to nefazodone . Buspirone is sometimes used off-label to reduce sexual dysfunction associated with
14061-424: The person's ability to keep commitments to changing their behaviors. These goals are attained by switching the person's attempt to control events to working towards changing their behavior and focusing on valued directions and goals in their lives as well as committing to behaviors that help the individual accomplish those personal goals. This psychological therapy teaches mindfulness (paying attention on purpose, in
14190-466: The possibility of ascertainment bias, e.g. that worried mothers may pursue more aggressive testing of their infants. Another study found no increase in cardiovascular birth defects and a 27% increased risk of major malformations in SSRI exposed pregnancies. The FDA issued a statement on July 19, 2006, stating nursing mothers on SSRIs must discuss treatment with their physicians. However, the medical literature on
14319-400: The predominant anti-inflammatories during the decade leading up to the introduction of the term "nonsteroidal anti-inflammatory drugs." Because of the disastrous reputation that the corticosteroids had got in the 1950s, the new term, which offered to signal that an anti-inflammatory drug was not a steroid, rapidly gained currency. The drug class of "nonsteroidal anti-inflammatory drugs" (NSAIDs)
14448-412: The present, and in a nonjudgmental manner) and acceptance (openness and willingness to sustain contact) skills for responding to uncontrollable events and therefore manifesting behaviors that enact personal values. Intolerance of uncertainty (IU) refers to a consistent negative reaction to uncertain and ambiguous events regardless of their likelihood of occurrence. Intolerance of uncertainty therapy (IUT)
14577-686: The product labels of SSRIs and SNRIs. Certain antidepressants may cause emotional blunting , characterized by reduced intensity of both positive and negative emotions as well as symptoms of apathy , indifference , and amotivation . It may be experienced as either beneficial or detrimental depending on the situation. This side effect has been particularly associated with serotonergic antidepressants like SSRIs and SNRIs, but may be less with atypical antidepressants like bupropion , agomelatine , and vortioxetine . Higher doses of antidepressants seem to be more likely to produce emotional blunting than lower doses. It can be decreased by reducing dosage, discontinuing
14706-430: The rehabilitation process of the individual. SPT allows a multi-sensory experience through a safe and protected space allowing the individual the opportunity to regulate their mind and emotions. This therapeutic practice is offered in both adults and children. There is empirical evidence that exposure therapy can be an effective treatment for people with GAD, citing specifically in vivo exposure therapy (exposure through
14835-1060: The relationship between GAD and activity levels in other parts of the frontal cortex is the subject of ongoing research with some literature suggesting greater activation in specific regions for individuals who have GAD but where other research suggests decreased activation levels in individuals who have GAD as compared to individuals who do not have GAD. Treatment includes psychotherapy (e.g., cognitive behavioral therapy [CBT] or metacognitive therapy ) and pharmacological intervention. CBT and selective serotonin reuptake inhibitors (SSRI) antidepressants (e.g., escitalopram , sertraline , and fluoxetine ) are first-line psychological and pharmacological treatments; other options include serotonin–norepinephrine reuptake inhibitors (SNRI) antidepressants (e.g., duloxetine and venlafaxine ). In more severe, last resort cases, potent anxiolytics such as diazepam , clonazepam , and alprazolam are used, though not as first-line drugs as benzodiazepines are frequently abused and habit forming. In Europe, pregabalin
14964-505: The relationship between cognition and behavior. Cognitive behavioral therapy (CBT) is widely regarded as the first-line psychological therapy for treating GAD. Additionally, many of these psychological interventions may be delivered in an individual or group therapy setting. While individual and group settings are broadly both considered effective for treating GAD, individual therapy tends to promote longer-lasting engagement in therapy (i.e., lower attrition over time). Psychodynamic therapy
15093-643: The risk of bleeding. Overdose of an SSRI or concomitant use with another agent that causes increased levels of serotonin can result in serotonin syndrome , which can be life-threatening. First line pharmaceutical treatments for GAD also include serotonin-norepinephrine reuptake inhibitors (SNRIs). These inhibit the reuptake of serotonin and noradrenaline to increase their levels in the CNS. FDA approved SNRIs used for this purpose include duloxetine (Cymbalta) and venlafaxine (Effexor). While SNRIs have similar efficacy as SSRIs, many psychiatrists prefer to use SSRIs first in
15222-637: The risk of cardiac malformations attributable to SSRI usage during the first trimester of pregnancy. A number of large studies of people without known pre-existing heart disease have reported no EKG changes related to SSRI use. The recommended maximum daily dose of citalopram and escitalopram was reduced due to concerns with QT prolongation . In overdose, fluoxetine has been reported to cause sinus tachycardia , myocardial infarction , junctional rhythms , and trigeminy . Some authors have suggested electrocardiographic monitoring in patients with severe pre-existing cardiovascular disease who are taking SSRIs. In
15351-460: The risk of suicidal behavior in adults. A 2017 meta-analysis found that antidepressants including SSRIs were associated with significantly increased risk of death (+33%) and new cardiovascular complications (+14%) in the general population. Conversely, risks were not greater in people with existing cardiovascular disease . SSRI use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation. As depression
15480-410: The safety of SSRIs has determined that some SSRIs like Sertraline and Paroxetine are considered safe for breastfeeding. Several studies have documented neonatal abstinence syndrome , a syndrome of neurological, gastrointestinal, autonomic, endocrine and/or respiratory symptoms among a large minority of infants with intrauterine exposure. These syndromes are short-lived, but insufficient long-term data
15609-405: The same mechanism of action , has also demonstrated effectiveness in the treatment of GAD, though unlike pregabalin, it has not been approved specifically for this indication. Nonetheless, it is likely to be of similar usefulness in the management of this condition, and by virtue of being off-patent, it has the advantage of being significantly less expensive in comparison. In accordance, gabapentin
15738-804: The same age (e.g., amygdala activation in adolescents with GAD). Traditional treatment modalities broadly fall into two categories, i.e., psychotherapeutic and pharmacological intervention. In addition to these two conventional therapeutic approaches, areas of active investigation include complementary and alternative medications (CAMs), brain stimulation, exercise, therapeutic massage and other interventions that have been proposed for further study. Treatment modalities can, and often are, utilized concurrently so that an individual may pursue psychological therapy (i.e., psychotherapy) and pharmacological therapy . Both cognitive behavioral therapy (CBT) and medications (such as SSRIs ) have been shown to be effective in reducing anxiety. A combination of both CBT and medication
15867-406: The severity of GAD symptoms. GAD is believed to have a hereditary or genetic basis (e.g., first-degree relatives of an individual who has GAD are themselves more likely to have GAD), but the exact nature of this relationship is not fully appreciated. Genetic studies of individuals who have anxiety disorders (including GAD) suggest that the hereditary contribution to developing anxiety disorders
15996-463: The treatment of stroke patients, including those with and without symptoms of depression. A 2021 meta-analysis of randomized controlled clinical trials found no evidence pointing to their routine use to promote recovery following stroke. SSRIs are effective for the treatment of premature ejaculation. Taking SSRIs on a chronic, daily basis is more effective than taking them prior to sexual activity. The increased efficacy of treatment when taking SSRIs on
16125-518: The treatment of Generalized Anxiety Disorder. The slightly higher preference for SSRIs over SNRIs as a first choice for treatment of anxiety disorders may have been influenced by the observation of poorer tolerability of the SNRIs in comparison to SSRIs in systematic reviews of studies of depressed patients. Side effects common to both SNRIs include anxiety, restlessness, nausea, weight loss, insomnia, dizziness, drowsiness, sweating, dry mouth, sexual dysfunction and weakness. In comparison to SSRIs,
16254-498: The use of SSRIs in the treatment of anorexia nervosa . Treatment guidelines from the National Institute of Health and Clinical Excellence recommend against the use of SSRIs in this disorder. Those from the American Psychiatric Association note that SSRIs confer no advantage regarding weight gain, but that they may be used for the treatment of co-existing depression, anxiety, or OCD. SSRIs have been used off-label in
16383-581: The use of SSRIs. A number of non-SSRI drugs are not associated with sexual side effects (such as bupropion , mirtazapine , tianeptine , agomelatine , tranylcypromine , and moclobemide ). Several studies have suggested that SSRIs may adversely affect semen quality. While trazodone (an antidepressant with alpha adrenergic receptor blockade) is a notorious cause of priapism , cases of priapism have also been reported with certain SSRIs (e.g. fluoxetine, citalopram). Post-SSRI sexual dysfunction (PSSD) refers to
16512-426: The various psychodynamic therapies attempt to explore the nature of worry as it functions in GAD in order to enable individuals to alter the subconscious practice of using worry as a defense mechanism and to thereby diminish GAD symptoms. Variations of psychotherapy include a near-term version of therapy, "short-term anxiety-provoking psychotherapy (STAPP). Behavioral therapy is therapeutic intervention premised upon
16641-418: Was lacking. In August 2021, a meta-analysis was presented at the 2021 International Conference on Intelligent Medicine and Health of articles published before January 2011 that found evidence for a negative impact of social media on anxiety. In January 2022, The European Journal of Psychology Applied to Legal Context published a meta-analysis of 13 cross-sectional studies comprising 7,348 subjects that found
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