Anxiety and Stress Disorders

Paroxetine for Anxiety

03/13/2005 01:52AM

Question:

I am a senior level executive. Of late, I have developed a habit of constantly thinking of something or the other. Secondly, I have also become fearful of reactions by others as a result of which I have become slightly timid. I cannot speak assertively when I am supposed to be assertive. An element of compromise has developed in me. Thirdly, if someone talks aggressively or if at all I start reacting in a similar way, I get palpitations and trembling and I feel I will lose my balance. I am also fearful of something unknown. If someone argues with me, I cannot react beyond a limit. I also feel scared of the reactions of my wife and daughter and I cannot be assertive with them. When I consulted doctor, he told me that the symptoms are akin to that of anxiety, panic disorder, emotional disturbance and OCD. He suggested Paroxetine Controlled Release 12.5. He explained to me that certain chemical imbalance causes such symptoms and these are reversible. I am hypertensive Please guide me.

Answer:

There are many ways to treat anxiety disorders. Selective Serotonin Reuptake Inhibitors (SSRI), like Paroxetine, are frequently used and considered first line by many experts. There are few data comparing the effectiveness and safety of the various SSRIs (including Paroxetine, Fluoxetine, escitalopram and sertraline) directly with each other. Lacking these data, some physicians have more experience with one or two of these, and use them the most. Others choose by cost (the generics, such as fluoxetine, are generally cheaper), others by side effects.

While symptoms usually begin to resolve within a few weeks to a month or two, it is usually recommended to continue treatment for at least 6 - 18 months to assure that symptoms (and the chemical imbalance) do not recur. Occasionally higher doses of the SSRIs are needed to treat anxiety than are needed to treat depression. And occasionally some people need to stay on medication for an indefinite time.

Research has also shown that therapy, specifically a type of therapy called Cognitive Behavioral Therapy (or CBT) is also effective in treating anxiety disorders. The best results have been shown in people who use a combination of medication and therapy.

High Blood Pressure is not a contraindication to treatment of anxiety -- the SSRIs do not interact with most medications for hypertension, but your physician should assess this when he/she prescribes for you.

Good luck.

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Response by:

Nancy Elder, MD
Associate Professor
Department of Family Medicine
College of Medicine
University of Cincinnati