Tag: panic disorder

Alprazolam (Xanax®, Niravam®)

Alprazolam is a short-acting benzodiazepine medication used in the treatment of anxiety disorders.  It acts as a positive allosteric modulator of synaptic GABAA receptors, increasing neuronal hyperpolarization and CNS depressant effects.  Alprazolam is the only benzodiazepine with significant antidepressant efficacy.

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Sertraline (Zoloft®)

Overview

Sertraline is a selective serotonin reuptake inhibitor drug used in the treatment of major depressive disorder and anxiety disorders.  It blocks the serotonin transporter (SERT) and increases CNS synaptic concentrations of serotonin, thereby enhancing serotonergic neurotransmission.  Through incompletely understood mechanisms, this contributes to both acute and adaptive neuronal changes that lead to improved mood and decreased anxiety.

Sertraline has approved uses in post-traumatic stress disorder, OCD, social anxiety, panic disorder, premenstrual dysphoric disorder, and major depressive disorder.  The most common adverse effects include dry mouth, drowsiness, and sexual dysfunction but use of the drug may be associated with more serious conditions.  Patients < 24y may experience increased suicidality, and patients with bipolar I/II can trigger a hypomanic/manic episode via sertraline exposure.  Concomitant use with other serotonergic medications (e.g., SNRIs, triptans) can also lead to serotonin syndrome.

In Plain English

Sertraline changes the chemical balance in your brain by increasing the amount of active serotonin, which regulates mood and stress.

Clinical Considerations

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Figure 1. Sertraline clinical considerations at a glance

Evidence Basis

  • For depression: http://www.cochrane.org/CD006117/DEPRESSN_sertraline-versus-other-antidepressive-agents-for-depression

 

Sertraline In the News

https://www.cbsnews.com/news/antidepressants-really-work-study-confirms-some-better-than-others/

 

 

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 9.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.

 

Venlafaxine (Effexor®)

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI)-class antidepressant drug used in the treatment of major depressive disorder (MDD) and several anxiety disorders.  Due to concerns about increased risk of suicide in younger patients, this drug is generally prescribed for selective serotonin reuptake inhibitor (SSRI)-refractory cases.

Venlafaxine works primarily by inhibiting presynaptic serotonin reuptake in the CNS, alongside less potent blockade of the norepinephrine and dopamine transport.  It has several off-label uses including post-traumatic stress disorder and migraine headache prophylaxis.

venlafaxine

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 April 29.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com