Selective serotonin reuptake inhibi...

Selective serotonin reuptake inhibitors (SSRIs) were initially disentangleed to relieve depression and have become the mostly commonly prescribed class of antidepressants. (1) SSRIs form the reuptake of serotonin at the presynaptic neuron with minimal or no import on norepinephrine or dopamine. This narrow mechanism of action hold a conferences similarity of efficacy and tolerability with not many side effects. (1)

The following five SSRIs have been approved from the U.S. Food and unsalable article Administration (FDA) for use in the United States: citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox) paroxetine (Paxil), and sertraline (Zoloft) Although the FDA has approved these SSRIs for treatment of a variety of conditions, the medical literature supports their use for a number of "off-label" indications. Off-label use does not imply improper or illegal use. (2) The FDA cannot give approval for further indications until it has reviewed of recent origin efficacy and safety data provided by way of the pharmaceutical companies.

The use of a well-documented therapy that lacks a specific "labeling" should not be preclud The decision to prescribe a given medication should be based upon the available evidence and a careful consideration of the potential risks and benefits in the words immediately preceding [i]or[/i] following of the individual patient.

This article reviews the use of SSRIs for six conditions commonly managed by the agency of family physicians: generalized anxiety disorder, premature ejaculation, migraine headache, diabetic neuropathy, fibromyalgia, and neurocardiogenic fainting (Table 1). (3-20)

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is single in kind of the most prevalent psychiatric disorders. Benzodiazepines similar as diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), which are used to treat GAD, can cause sedation, difficulty concentrating, and other bothersome side issues Dependence can develop, leading to withdrawal symptoms forward discontinuation of these agents. Buspirone (BuSpar), a nonbenzodiazepine anxiolytic that does not lead to trust is an effective alternative, further it must be taken three times daily. (21)

SSRIs have been prescribed safely and effectively for mixed anxiety and depression syndrome as well as for social anxiety. (22) Paroxetine may be effective for GAD treatment. (5) [Evidence even A, randomized controlled trial (RCT)]

In the trial, (5) 81 patients were randomized to treatment with paroxetine (20 mg daily), imipramine (Tofranil), or the benzodiazepine 2'chlordesmethyldiazepam. The patients had a diagnosis of GAD according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV), a score of at least 18 in succession the Hamilton Rating Scale for Anxiety (HRSA), and no comorbid psychiatric conditions. The patients ranged from 18 to 65 years of age. Demographics were similar in each form into groups Sixty-three patients (77.7 percent) complet the meditation Using the HRSA to measure rejoinder 68 percent of the patients in the paroxetine cluster 72 percent in the imipramine assign places to and 55 percent in the 2'chlordesmethyldiazepam cluster had at least a 50 percent decrease in HRSA score by dint of the end of the eight-week investigation Paroxetine was recently approved by dint of the FDA for GAD treatment.

SSRIs may be particularly useful in the treatment of GAD in pediatric patients. (3) [Evidence horizontal A, RCT] In a multicenter, double-blind trial, 128 children six to 17 years of age with social phobia, separation anxiety disorder, or GAD (as defined according to DSM-IV) were randomized to treatment with fluvoxamine or placebo. (3) All had received three weeks of psychotherapy without showing improvement. Fluvoxamine was chosen because it was the sole SSRI approved by the FDA for use in children in 1996 when the meditation was designed. Fluvoxamine therapy (at a maximum dosage of 300 mg daily) conclusioned in a statistically significant decrease in scores in succession the Pediatric Anxiety Rating Scale compared with placebo. Although this trial was not specific to GAD, it was noted that anxiety disorders in children typically arise together, thereby making it difficult to isolate individual disorder for study.

SSRIs be seen particularly suited for use in older patients with anxiety disorders. (4) [Evidence even B, nonrandomized trial] In a small, open-label trial, patients more than 50 years of age with GAD, panic disorder, or obsessive-compulsive disorder were treated with fluvoxamine (median dose, 200 mg daily). (4) Twelve of 19 patients (63 percent) complet the 21-week research with eight of the 12 (666 percent) achieving a 50 percent reduction in symptoms as measured according to standardized scales. The existence of comorbid depression, as well as the confounding variable of therapy combined with benzodiazepines, were brace further limitations of this trial. The authors judge that randomized, placebo-controlled trials are warranted to research the use of SSRIs for treatment of anxiety disorders in the older population.

Premature Ejaculation

although premature ejaculation has been overshadowed from recent attention given to erectile dysfunction, it is the most numerous prevalent form of male sexual dysfunction. (23) Delayed or inhibited ejaculation, a known side purport of SSRIs, has made SSRIs potentially useful in the treatment of this disorder. The ejaculation-delaying consequence was analyzed in a double-blind, placebo-controlled trial complet by dint of 51 men. (6) Fluoxetine, sertraline, and paroxetine have been build to increase the latent period of intravaginal ejaculation and therefore to be beneficial in patients who prematurely ejaculate. (6) [Evidence on a level A, RCT] Fluvoxamine had the least meaning in increasing ejaculatory latency, a difference that was not statistically significant compared with placebo. Citalopram was not studied.