Which medications in the drug class Selective Serotonin Reuptake Inhibitors are used in the treatment of Anxiety Disorders?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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Selective Serotonin Reuptake Inhibitors

The SSRIs include paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa). SSRIs are first-line agents for long-term management of anxiety disorders, with control gradually achieved over a 2- to 4-wk course, depending on required dosage increases.

SSRIs are helpful for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), and social phobia. All SSRIs may be equal in the treatment of anxiety disorders; however, higher doses may be necessary in the treatment of OCD.

All commonly used SSRIs appear to have a role in the treatment of panic disorder. However, patients with panic disorder may be more sensitive to treatment with antidepressants and frequently need lower initial doses and slower titration to accomplish successful therapy.

Fluoxetine has a very long half-life, making it well suited for patients who have difficulty remembering to take all of their medications each day. The longer half-life also minimizes the risk and severity of SSRI withdrawal that can occur when patients exhaust or abruptly discontinue their SSRI.

Paroxetine (Paxil)

Alternative sedating SSRI. Potent selective inhibitor of neuronal serotonin reuptake. Also has weak effect on norepinephrine and dopamine neuronal reuptake. For maintenance dosing, make dosage adjustments to maintain patient on lowest effective dosage, and periodically reassess patient to determine need for continued treatment.

Escitalopram (Lexapro)

FDA approved for generalized anxiety disorder. SSRI and S-enantiomer of citalopram. Used for the treatment of depression. Mechanism of action is thought to be potentiation of serotonergic activity in central nervous system resulting from inhibition of CNS neuronal reuptake of serotonin. Onset of depression relief may be obtained after 1-2 wk, which is sooner than other antidepressants.

Sertraline (Zoloft)

FDA-approved for panic disorder, PTSD, social phobia, and OCD. May be helpful for other anxiety disorders.

Fluoxetine (Prozac)

FDA-approved for OCD and panic disorder. May be helpful for other anxiety disorders.

Fluvoxamine (Luvox)

FDA approved for OCD in children (8-17 y) and adults. May be helpful for other anxiety disorders.

Citalopram (Celexa)

Enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane. Citalopram is a 50:50 racemate of r- and s-citalopram. Reports of dose-dependent QT interval limit dose escalation and coadministration with CYP2C19 inhibitors.

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