Paxil sedating - the mentalist s06e13 online dating
Typical starting, therapeutic, and maximum dosages for antidepressants are shown in Estimated cost based on typical therapeutic daily dose range to the pharmacist based on average wholesale prices in Red Book. Costs in parentheses are for generic drugs Estimated cost based on typical therapeutic daily dose range to the pharmacist based on average wholesale prices in Red Book. Costs in parentheses are for generic drugs The dosage of antidepressant should be slowly increased.Clinical experience suggests that seven days is usually an appropriate interval.2Drug response varies with individual patients.
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.It may take even longer before patients stop avoiding feared situations and are relieved of generalized anxiety.Accordingly, as long as some meaningful improvement occurs in four to six weeks after initiation of therapy, several months should be allowed to pass before assessing the full effect of the drug and considering a change in therapy.1Benzodiazepines are effective in treating panic disorder5; they are also used to treat generalized anxiety disorder and social phobia, two common comorbidities of panic disorder.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.It may take several months for the patient to feel confident that he or she is free of panic attacks.Selective serotonin reuptake inhibitors (SSRIs) are the drug of choice for treatment of patients with panic disorder.
Most patients have a favorable response to SSRI therapy; however, 30 percent will not be able to tolerate these drugs or will have an unfavorable or incomplete response.
Accordingly, the development of panic that is refractory to treatment in a patient with previously well-controlled panic disorder should prompt rescreening for these disorders.
With increasing age, patients may develop medical comorbidities that can interact with panic phenomenology to produce refractory panic symptoms.2627 have proposed guidelines for treatment selection but, except for a general preference to begin with an SSRI or CBT, the recommendations differ.
Unfortunately, there are no controlled trials to guide the next therapeutic selection.18 The recommendations of these groups and the authors’ clinical experience are synthesized in the algorithm presented in View/Print Figure FIGURE 1.
Algorithm for sequencing treatment for panic disorder.
In contrast to antidepressants, benzodiazepines relieve anxiety within hours,7 can prevent panic attacks within a few days to a few weeks,5 and are free of troublesome activating effects.7 Nevertheless, benzodiazepine use in treating panic disorder can be complicated by abuse, physiologic and psychologic dependence, and sedative and neurocognitive side effects.7Beta blockers, once widely touted as effective antipanic medications, have proven disappointing as monotherapy in subsequent placebo-controlled trials.5 Buspirone (Bu Spar) is ineffective as monotherapy for panic disorder, as is the antidepressant bupropion (Wellbutrin).5 Traditional forms of psychotherapy (psychodynamic, insight-oriented, and supportive) have little proven benefit in treating panic disorder, but they may be efficacious in treating comorbidities or to help patients adapt to their condition.10When directly questioned by a physician, about 60 percent of patients who take SSRIs report experiencing sexual dysfunction, including delayed orgasm, anorgasmia, loss of libido, decreased lubrication, and erectile dysfunction11; that number drops to 14 percent when patients spontaneously report the information.12 Only 25 percent of these patients with sexual dysfunction report being able to tolerate this side effect—presenting a major challenge because of the long-term nature of the treatment.12In general, the sexual dysfunction is dose-related and responds to reductions in the total amount of antidepressant medication used.1112 Occasionally, patients can successfully alter the time of dosing or skip doses prior to sexual activity.