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References Depression and anxiety disorders CHAPTER 3 26. Nicolussi S, et al. Clinical relevance of St. John’s wort drug interactions revisited. Br J Pharmacol 2020; 177:1212–1226. 27. Imai H, et  al. The recovery time-­course of CYP3A after induction by St Jo...

Antidepressants: relative adverse effects – a rough guide 446 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Anxiety spectrum disorders Anxiety disorders can occur in isolation, be comorbid with other psychiatric disorders (particularly depressio...

Anxiety spectrum disorders

Benzodiazepines

Use of antidepressants in anxiety spectrum disorders

SSRIs/SNRIs Depression and anxiety disorders CHAPTER 3 all drugs may be effective when standard doses have failed. Efficacy of SSRIs (but not SNRIs) increases across the licensed dose range in anxiety disorders.19 Onset of action may be as long as 6  weeks. Wo...

Pregabalin 448 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 overdose toxicity of opiates.38 Pregabalin should not be stopped abruptly as it may precipitate a severe withdrawal syndrome that includes seizures.39 Psychological approaches There is...

Psychological approaches Depression and anxiety disorders CHAPTER 3 OCD (where there is moderate or severe functional impairment) ■ ■Use an SSRI or intensive CBT. ■ ■Combine the SSRI and CBT if the response to a single strategy is suboptimal. ■ ■Use clomiprami...

Summary of NICE guidelines for the treatment of GAD, panic disorder and OCD Depression and anxiety disorders CHAPTER 3 References Nash JR, et al. Pharmacotherapy of anxiety. HandbExp Pharmacol 2005; (169):469–501. Munkholm K, et al. Minor tranquillizers for s...

Panic disorder

GAD

OCD (where there is moderate or severe functional impairment)

References 456 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 19. Jakubovski E, et al. Systematic review and meta-­analysis: dose-­response curve of SSRIs and SNRIs in anxiety disorders. Depress Anxiety 2019; 36:198–212. 20. Clayton AH, et al. Se...

Benzodiazepines in the treatment of psychiatric disorders

Anxiolytic effect

References 340 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Toxicity in overdose varies both between and within groups of antidepressants42 (see section on psychotropics in overdose in Chapter 13). Duration of treatment Antidepressants relieve ...

Hypnotic effect Depression and anxiety disorders CHAPTER 3 Use in depression Benzodiazepines are not a treatment for major depressive illness. The only meta-­analysis conducted found no advantage for benzodiazepines over placebo in depression.20 However, there...

Use in depression