BEST SSRI FOR ANXIETY AND INSOMNIA TRIAL

Sertraline is slowly absorbed from the gastrointestinal tract with peak serum levels occurring between 6 and 8 hours after administration. In this study, youth, aged 7–17 years of age were randomized to fixed dose fluoxetine (20 mg/day, n=37) or placebo ( n=37) for 12 weeks 61% of patients fluoxetine-treated youth (compared to 35% of those receiving placebo) responded in terms of CGI categorical outcome and fluoxetine was well tolerated.

BEST SSRI FOR ANXIETY AND INSOMNIA TRIAL

While relatively few studies have evaluated the efficacy of fluoxetine in adults with GAD, fluoxetine has been studied in a large randomized controlled trial (RCT) of pediatric patients with generalized, separation and/or social anxiety disorders. Additionally, fluoxetine is highly protein bound, and because of its extensive CYP2D6-dependent metabolism may, exhibit considerable intra-individual variability in tolerability and response. Compared to its parent compound fluoxetine, which has a half-life of 4–6 days, norfluoxetine has a half-life in the order of two weeks. Fluoxetine, which is primarily metabolized through the CYP2D6 system, also inhibits CYP2D6 activity and its active metabolite, norfluoxetine, inhibits CYP3A4. Fluoxetine increases central serotonergic transmission, but it also has noradrenergic and dopaminergic effects which putatively underlie its therapeutic efficacy.

Originally synthesized in the early 1970s, fluoxetine became the first SSRI to be introduced in the United States in 1987. The latter notes that the SSRIs “have ‘broad spectrum’ efficacy in both short-term and long-term treatment, and are generally well tolerated and for these reasons are widely considered to be the first-line pharmacological approach in patients with anxiety disorders”. The use of SSRIs in the treatment of GAD is endorsed by both the 2014 Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders and the British Association for Psychopharmacology 2014 Guidelines. Furthermore, these compounds all differ in their metabolism, side effect profiles, and duration of action. The SSRIs ( Figure 1) differ significantly in terms of the potency and selectivity for the 5-HT transporter relative to norepinephrine and dopamine transporters, as well as in their ability to interact with other synaptic and extra-synaptic receptors, which subtends their variable efficacy and side effect profiles. Inhibition of 5-HT reuptake increases the concentrations of synaptic 5-HT, which in turn increases extra-synaptic diffusion. The SSRIs inhibit serotonin (5-hydroxytryptamine, 5-HT) reuptake transporter and in some cases weakly inhibit dopamine and norepinephrine reuptake mechanisms. Herein the evidence and clinical use of these medications and their related classes will be reviewed.Ģ.1. To date, randomized controlled trials, open-label studies, and other data support the efficacy of selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively), as well as benzodiazepines, monoamine oxidase inhibitors, tricyclics, azapirones, anti-adrenergic medications, antihistamines, melatonin analogues, second generation antipsychotics in addition to trazodone. The last 4 decades saw rapid progress in the systematic evaluation of numerous psychopharmacologic interventions for GAD in pediatric and adult populations. somatic) and the addition of psychotherapy increases treatment adherence and decreases reported side effects of pharmacotherapy. Additionally, multimodal approaches ( e.g., psychotherapy and pharmacotherapy) may differentially target specific symptoms ( e.g., cognitive vs. In fact, numerous studies suggest concurrent psychotherapy amplifies the benefits of pharmacotherapy ( e.g., sertraline, fluoxetine, etc.). Treatment of GAD and other anxiety disorders in children and adults frequently consists of both psychotherapy and pharmacotherapy. In addition to inflicting significant individual, societal and economic costs, untreated GAD increases the likelihood of developing secondary disorders, including major depressive disorder (MDD), other anxiety disorders and increases the risk of suicide attempt and completed suicide across the lifespan. Characterized by pervasive, diffuse anxiety related to multiple domains, GAD affects up to 5% of children and adolescents and between 3–6% of adults. Generalized anxiety disorder (GAD), a chronic illness, often begins during adolescence or early adulthood, and persists throughout the lifespan.

Best ssri for anxiety and insomnia