Anxiolytics

2008 ◽  
Author(s):  
Deirdre Johnston
Keyword(s):  
Major Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serum Levels ◽  
The Elderly ◽  
Physical Symptoms ◽  
Anxiety Symptoms ◽  
Panic Attacks ◽  
Generalized Anxiety ◽  
Low Doses

Anxiety disorders may occur as primary conditions (generalized anxiety, panic disorder); or may be associated with other psychiatric syndromes such as major depression or dementia. Benzodiazepines are the most widely prescribed anxiolytics. However, antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) also have potent anxiolytic properties; these agents are often safer and more effective in the long-termtreatment of generalized anxiety and panic attacks. Buspirone is occasionally effective for relatively milder forms of generalized anxiety. Neurologists evaluating anxious patients should have a high suspicion for the diagnosis of depression, because major depression can present with predominant anxiety symptoms, particularly in the elderly in whom agitation associated with depression may mimic severe anxiety (Schoevers et al., 2003). The neurologist may also encounter anxiety symptoms in patients with Alzheimer’s disease, vascular dementia, or following stroke. General medical causes of anxiety symptoms should be included in the differential diagnosis before anxiolytic treatment is begun. Such medical etiologies include hyperthyroidism, respiratory distress, cardiac arrhythmias, hypoglycemia, and pheochromocytoma. Moreover, physical discomfort may provoke anxiety symptoms in cognitively impaired patients who cannot express their physical symptoms to caregivers. Generalized anxiety, especially if accompanied by depression, is best treated with antidepressant agents. Benzodiazepines may produce benefits in the short term, if distress is great, but the long-term use risks the induction of physiologic dependence. The SSRIs sertraline and paroxetine, as well as the SNRI venlafaxine, are effective for generalized anxiety. Each drug should be started at low doses (sertraline 25mg daily, paroxetine 10mg QHS, extended-release venlafaxine 37.5mg daily) and slowly increased as tolerated. Final doses are similar to those required for the treatment of major depression, and slow dose escalation minimizes early exacerbation of anxiety symptoms. See Chapter 15 for further description of these agents, including side effects. TCAs are second-line agents for the treatment of generalized anxiety. Nortriptyline is the best tolerated TCA. It should be started at low doses (10mg QHS) and slowly increased as tolerated. Final doses generally need to achieve serum levels similar to those required for the treatment of major depression. Details of nortriptyline use can be found in Chapter 15.

Maintenance Therapies for Late-Life Recurrent Major Depression: Research and Review Circa 1995

1995 ◽  
Vol 7 (S1) ◽  
pp. 27-39 ◽  
Author(s):  
Charles F. Reynolds III ◽  
Ellen Frank ◽  
James M. Perel ◽  
Sati Mazumdar ◽  
David J. Kupfer
Keyword(s):  
Major Depression ◽  
Maintenance Therapy ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Monoamine Oxidase Inhibitor ◽  
Treatment Compliance ◽  
The Elderly ◽  
Term Therapy ◽  
Placebo Control ◽  
Long Term Treatment

Major depression in the elderly is often a relapsing, chronic illness with high risk for chronic invalidism, poor treatment compliance, and suicide. In most cases, maintenance treatment to prevent recurrence and to enhance the quality of life is thought to be indicated. We review recent data from our onging studies that support both the efficacy and the safety of pharmacotherapeutic and psychotherapeutic maintenance treatments. However, the challenges of conducting maintenance therapy research (particularly with a placebo control) with the elderly are many, involving such areas as recruitment, retention, compliance, choice of outcome measures, and informed consent. We discuss each of these challenges and our responses to them. Finally, we suggest that maintenance therapy trials should be extended in several directions: (a) long-term treatment of bipolar and delusional subtypes in the elderly, as well as depression associated with progressive neurodegenerative disorders such as Alzheimer's dementia; (b) assessment of the benefits and risks of long-term therapy with other than tricyclic and monoamine oxidase inhibitor antidepressant agents, such as selective serotonin reuptake inhibitors; and (c) development of models of long-term course, including the interaction of treatments with medical and psychosocial variables that can have a profound impact on illness onset and offset. These issues are illustrated with a discussion of a new protocol designed to test the acute and maintenance efficacy of antidepressant therapy for depressed patients with Alzheimer's disease.

A review of the efficacy and tolerability of venlafaxine

1997 ◽  
Vol 12 (S4) ◽  
pp. 307s-313s ◽  
Author(s):  
M Dierick
Keyword(s):  
Major Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Activity ◽  
Term Treatment ◽  
Selective Serotonin ◽  
First Line Therapy ◽  
Long Term Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Short And Long Term

SummaryVenlafaxine is a selective serotonin norepinephrine reuptake inhibitor with no activity at muscarinic, histaminergic or adrenergic receptors. The antidepressant activity of venlafaxine has been demonstrated in placebo-controlled and active comparator-controlled clinical trials. Venlafaxine was effective in outpatients and hospitalized patients with major depression and in those with melancholia, agitated or retarded symptoms, and refractory or treatment-resistant depression. Venlafaxine was at least as effective as comparative antidepressants and was more effective than fluoxetine or imipramine in some trials. A positive dose-response relationship has been shown with venlafaxine. When doses of venlafaxine are titrated rapidly upward, an onset of antidepressant action has been detected within one week in some studies. Venlafaxine is well tolerated during short- and long-term treatment. The most common adverse effects are nausea, somnolence and dry mouth. The overall tolerability of venlafaxine appears to exceed that of tricyclic antidepressants and compares favorably with that of selective serotonin reuptake inhibitors. Venlafaxine is a novel antidepressant that is appropriate for first-line therapy in patients with major depression.

scholarly journals Efficacy of Citalopram in the prevention of recurrent depression in elderly patients: Placebo-controlled study of maintenance therapy

2002 ◽  
Vol 181 (1) ◽  
pp. 29-35 ◽  
Author(s):  
René Klysner ◽  
Jesper Bent-Hansen ◽  
Hanne L. Hansen ◽  
Marianne Lunde ◽  
Elisabeth Pleidrup ◽  
...  
Keyword(s):  
Major Depression ◽  
Elderly Patients ◽  
Rating Scale ◽  
The Elderly ◽  
Term Treatment ◽  
Fixed Dose ◽  
Controlled Study ◽  
Recurrence Time ◽  
Long Term Treatment

BackgroundThe highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment.AimsTo compare the prophylactic efficacy of citalopram and placebo in elderly patients; to evaluate long-term tolerability of citalopram.MethodOut-patients, ⩾65 years, with unipolar major depression (DSM – IV: 296.2 x or 296.3 x) and Montgomery – Åsberg Depression Rating Scale score ⩾22 were treated with citalopram 20–40 mg for 8 weeks. Responders continued on their final fixed dose of citalopram for 16 weeks before randomisation to double-blind treatment with citalopram or placebo for at least 48 weeks.ResultsNineteen of the 60 patients using citalopram v. 41 of the 61 patients using placebo had recurrence. Time to recurrence was significantly different between citalopram— and placebo-patients, in favour of citalopram (log-rank test, P < 0.0001). Long-term treatment was well tolerated.ConclusionsLong-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.

scholarly journals Tolerability and Efficacy of Vortioxetine Versus SSRIs in Elderly With Major Depression. Study Protocol of the VESPA Study: A Pragmatic, Multicentre, Open-Label, Parallel-Group, Superiority, Randomized Trial

2020 ◽  
Author(s):  
Giovanni Ostuzzi ◽  
Chiara Gastaldon ◽  
Angelo Barbato ◽  
Barbara D’Avanzo ◽  
Mauro Tettamanti ◽  
...  
Keyword(s):  
Major Depression ◽  
Randomized Trial ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scales ◽  
Rating Scale ◽  
The Elderly ◽  
Tolerability Profile ◽  
Open Label ◽  
Parallel Group

Abstract Introduction. Depression is a highly prevalent condition in the elderly, with a vast impact on quality of life, life expectancy, and medical outcomes. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed agents in this condition and, although generally safe, tolerability issues cannot be overlooked. Vortioxetine is an antidepressant with a novel mechanism of action. Based on available studies, it may have a promising tolerability profile in the elderly, as it does not adversely affect psychomotor or cognitive performance, and does not alter cardiovascular and endocrine parameters. The present study aims to assess the tolerability profile of vortioxetine in comparison with the SSRIs considered as a single group in elderly participants with depression. The rate of participants withdrawing from treatment due to adverse events after six months of follow-up will be the primary outcome. Methods and analysis. This is a pragmatic, multicentre, open-label, parallel-group, superiority, randomized trial funded by the Italian Medicines Agency (AIFA - Agenzia Italiana del Farmaco ). Thirteen Italian Community Psychiatric Services will consecutively enrol elderly participants suffering from an episode of major depression over a period of 12 months. Participants will be assessed at baseline and after 1, 3 and 6 months of follow-up. At each time point, the following validated rating scales will be administered: Montgomery–Åsberg Depression Rating Scale (MADRS), Antidepressant Side-Effect Checklist (ASEC), EuroQual 5 Dimensions (EQ-5D), Short Blessed Test (SBT), and Charlson Age-Comorbidity Index (CACI). Outcome assessors and the statistician will be masked to treatment allocation. A total of 358 participants (179 in each group) will be enrolled. Ethics and dissemination. This study will fully adhere to the ICH E6 Guideline for Good Clinical Practice. Participants’ data will be managed and safeguarded according to the European Data Protection Regulation 2016/679. An external Ethical Advisory Board will help guarantee high ethical standards. Trial registration number. EudraCT number: 2018-001444-66; Clinicaltrials.gov: NCT03779789, first submitted on December 12, 2018 and first posted on December 19 th trial status: protocol version 1.5; 09/06/2018. Recruitment started on February 2019 and it is ongoing. It is expected to end approximately on September 30 th 2021.

scholarly journals Tolerability and Efficacy of Vortioxetine Versus SSRIs in Elderly with Major Depression. Study Protocol of the Vespa Study: A Pragmatic, Multicentre, Open-Label, Parrallel-Group, Superiority, Randomized Trial

2019 ◽  
Author(s):  
Giovanni Ostuzzi ◽  
Chiara Gastaldon ◽  
Angelo Barbato ◽  
Barbara D’Avanzo ◽  
Mauro Tettamanti ◽  
...  
Keyword(s):  
Major Depression ◽  
Randomized Trial ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scales ◽  
Rating Scale ◽  
Good Clinical Practice ◽  
The Elderly ◽  
Tolerability Profile ◽  
Open Label

Abstract Introduction. Depression is a highly prevalent condition in the elderly, with a vast impact on quality of life, life expectancy, and medical outcomes. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed agents in this condition and, although generally safe, tolerability issues cannot be overlooked. Vortioxetine is an antidepressant with a novel mechanism of action. Based on available studies, it may have a promising tolerability profile in the elderly, as it does not adversely affect psychomotor or cognitive performance, and does not alter cardiovascular and endocrine parameters. The present study aims to assess the tolerability profile of vortioxetine in comparison with the SSRIs considered as a single group in elderly participants with depression. The rate of participants withdrawing from treatment due to adverse events after six months of follow-up will be the primary outcome. Methods and analysis. This is a pragmatic, multicentre, open-label, parallel-group, superiority, randomized trial funded by the Italian Medicines Agency (AIFA - Agenzia Italiana del Farmaco). Thirteen Italian Community Psychiatric Services will consecutively enrol elderly participants suffering from an episode of major depression over a period of 12 months. Participants will be assessed at baseline and after 1, 3 and 6 months of follow-up. At each time point, the following validated rating scales will be administered: Montgomery–Åsberg Depression Rating Scale (MADRS), Antidepressant Side-Effect Checklist (ASEC), EuroQual 5 Dimensions (EQ-5D), Short Blessed Test (SBT), and Charlson Age-Comorbidity Index (CACI). Outcome assessors and the statistician will be masked to treatment allocation. A total of 358 participants (179 in each group) will be enrolled. Ethics and dissemination. This study will fully adhere to the ICH E6 Guideline for Good Clinical Practice. Participants’ data will be managed and safeguarded according to the European Data Protection Regulation 2016/679. An external Ethical Advisory Board will help guarantee high ethical standards. Trial registration number. EudraCT number: 2018-001444-66; Clinicaltrials.gov: NCT03779789, first submitted on December 12, 2018 and first posted on December 19th trial status: protocol version 1.5; 09/06/2018. Recruitment started on February 2019 and it is ongoing. It is expected to end approximately on September 30th 2021.

scholarly journals New-Onset Panic, Depression with Suicidal Thoughts, and Somatic Symptoms in a Patient with a History of Lyme Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Amir Garakani ◽  
Andrew G. Mitton
Keyword(s):  
Depressive Symptoms ◽  
Lyme Disease ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Physical Symptoms ◽  
Panic Attacks ◽  
Depression And Anxiety ◽  
Chronic Lyme Disease ◽  
History Of

Lyme Disease, or Lyme Borreliosis, caused byBorrelia burgdorferiand spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient’s panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected “chronic Lyme Disease” (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses.

scholarly journals Gambaran Tingkat Depresi pada Lansia di Wilayah Kerja Puskesmas Guguak Kabupaten 50 Kota Payakumbuh

2019 ◽  
Vol 1 (2) ◽  
pp. 12-16
Author(s):  
Mutiara Anissa ◽  
Rinita Amelia ◽  
Nadia Purnama Dewi
Keyword(s):  
Quality Of Life ◽  
High School ◽  
Major Depression ◽  
The Elderly ◽  
Physical Symptoms ◽  
Mild Depression ◽  
Level Of Education ◽  
Symptoms Of Depression ◽  
History Of

Depression is a mental disorder that is often found in the elderly. Symptoms of depression in the elderly are often covered by physical symptoms. Depression in the elderly is influenced by various factors such as biology, psychology and social. Depression can further reduce the quality of life in the elderly. The study is a descriptive observational study and observed on 30 subjects were carried out on April 7, 2018. Aim of the study to determine the description of the Depression Rate in the Elderly in the Guguak Health Center Working Area District 50 Payakumbuh City. In the study, the subjects were 8 men (11.3%) and 22 women (73.3%). Theaverage subject age is 69.3. year. The highest level of education in the study subjects was high school (40%). Most patients did not have a history of other medical diseases (60%). In the study, 33.3% of the elderly were depressed. The levels of depression experienced were mild depression (23.3%) and major depression (10%).

WCA Recommendations for the Long-Term Treatment of Generalized Anxiety Disorder

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S1) ◽  
pp. 53-61 ◽  
Author(s):  
Christer Allgulander ◽  
Borwin Bandelow ◽  
Eric Hollander ◽  
Stuart A. Montgomery ◽  
David J. Nutt ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Physical Dependence ◽  
The United States ◽  
Term Treatment ◽  
Generalized Anxiety ◽  
Treatment Trials ◽  
Long Term Treatment

ABSTRACTWhat are the current recommendations for the long-term treatment of generalized anxiety disorder (GAD)? GAD is a common disorder with a lifetime prevalence of 4% to 7% in the general population. GAD is characterized by excessive, uncontrollable worry or anxiety about a number of events or activities that the individual experiences on more days than not over a 6-month period. Onset of GAD symptoms usually occurs during an individual's early twenties; however, high rates of GAD have also been seen in children and adolescents. The clinical course of GAD is often chronic, with 40% of patients reporting illness lasting >5 years. GAD is associated with pronounced functional impairment, resulting in decreased vocational function and reduced quality of life. Patients with GAD tend to be high users of outpatient medical care, which contributes significantly to healtcare costs. Currently, benzodiazepines and buspirone are prescribed frequently to treat GAD. Although both show efficacy in acute treatment trials, few long-term studies have been perform Benzodiazepines are not recommended for long-term treatment of GAD, due to associated development of tolerance, psychomotor impairment, cognitive and memory changes, physical dependence, and a withdrawal reaction on discontinuation. The antidepressant venlafaxine extended-release (XR) has received approval for the treatment of GAD in the United States and many other countries. Venlafaxine XR has demonstrated efficacy over placebo in two randomized treatment trials of 6 months' duration as well as in other acute trials. Paroxetine is the first of the selective serotonin reuptake inhibitors (SSRIs) to receive US approval for the treatment of GAD. Paroxetine demonstrated superiority to placebo in short-term trials, and investigations into the use of other SSRIs are ongoing. This suggests that other SSRIs, and serotonin and noradrenaline reuptake inhibitors, are likely to be effective in the treatment of GAD. Of the psychological therapies, cognitive-behavioral therapy (CBT) shows the greatest benefit in treating GAD patients. Treatment gains after a 12-week course of CBT may be maintained for up to 1 year. Currently, no guidelines exist for the long-term treatment of GAD.

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