Ssri activating sedating
Clinical experience suggests that seven days is usually an appropriate interval.2Drug response varies with individual patients.
Typically, patients who have panic disorder require dosages at the high end of the therapeutic range for SSRIs, and full dosages for TCAs, as shown in 6 Before switching to a different agent, the highest recommended dosage for a given SSRI should be tried as long as the drug is tolerated.
Nefazodone15 and mirtazapine16 are also likely to be useful in treating panic disorder; use of these agents has a low risk of sexual dysfunction.17 Benzodiazepines may be an appropriate alternative if there is no contraindication to their use and if patients are not able to tolerate an antidepressant trial.18 CBT is presumably free of sexual side effects.
Anecdotally, self-help groups like Agoraphobics in Motion, 1719 Crooks Rd., Royal Oak, MI 48067; telephone: 248-547-0400, can be inexpensive and helpful.22 Patients with panic disorder commonly have other comorbidities including mood and anxiety disorders, and substance use.23 Because these disorders may be associated with panic attacks and anticipatory anxiety23 and may require distinct treatments,4 the diagnosis of panic disorder should consistently trigger a systematic search for other anxiety disorders.22 Because the common comorbidities of panic disorder respond differentially to antipanic treatments, knowledge of these comorbidities also helps in treatment selection. I.),24 which takes less than 20 minutes to complete, is a more effective screening tool.
For example, using the sedating agents mirtazapine or nefazodone would be a good choice for patients with ongoing comorbid sleep difficulties, and sildenafil would be appropriate for the patient whose main problem is erectile dysfunction.
Finally, switching to a different category of antipanic drug, such as tricyclic antidepressants, is another possibility.
While most patients have a favorable response to SSRI therapy, 30 percent will not be able to tolerate these medications or will have an unfavorable or incomplete response.1 Eight strategies to manage patients who have not tolerated initial therapy or who have had an unsatisfactory response to it are presented here.3 The initial activating effects of SSRIs and tricyclic antidepressants (TCAs) can be especially troubling.4 As a result, many patients abandon SSRI therapy before they experience any benefits.
Following are several strategies to help patients overcome resistance to therapy.