In addition, SSRIs have side ...

In addition, SSRIs have side effects such as increase in appetite and weight gain, nausea, diarrhea, constipation, dry mouth, sweating, sleep disturbance, sexual function (libido and orgasm), a number of other cholinolytic side effects lowering the threshold of convulsive readiness, the possibility of withdrawal, and drug interactions. Tricyclic antidepressants have a more pronounced holino-, adrenolytic, adrenergic and other side effects. This impairs the portability and increases the list of contraindications to their use, particularly in patients with concomitant somatic diseases. In addition, studies on long-term use of tricyclic antidepressants in GAD are not available. On the other hand, antidepressants are undeniable, and the main advantage - actually an antidepressant effect. For this reason, the SSRIs should be prescribed for the treatment of GAD in those cases when he was accompanied by depression or other anxiety disorders such as panic, social phobia, obsessive-compulsive disorder (obsessive-compulsive disorder). Tricyclic antidepressants should be left in reserve in case of failure of SSRIs. The effectiveness of tianeptine in GAD has not been studied, and recommendations for GAD is not included [12.21]. In addition to the above considerations, has a meaning and a psychological barrier to the use of antidepressants, which still holds the doctors somatic disciplines, and in many patients. Clinical experience shows that the patient readily accepted the appointment of "soothing", sedatives, ie proper protivotrevozhnyh (anxiolytic) agents. The most common ones include drugs benzodiazepine group - oksazepam, lorazepam, alprazolam, tofisopam, phenazepam, Medazepam, bromazepam, diazepam, clonazepam, and others. In addition protivotrevozhnogo and sedative effects, benzodiazepines have hypnotic and myorelaxant action, in various degrees in different drugs in this group. They differ in duration. Despite the fact that benzodiazepines are recommended for the treatment of GAD [12.28], they have several disadvantages [10]. Although benzodiazepines quickly cease sleep disorders and many physical symptoms of anxiety, the mental symptoms of GAD are less influenced by [14.38], so that after their withdrawal Patients often report a rapid resumption of symptoms [72]. The use of benzodiazepines is associated with the risk of habituation and the formation of drug dependence, so that drugs in this group should not take longer than 2-4 weeks, which makes them unsuitable for long-term treatment of GAD. Chronic administration of benzodiazepines, in addition to the risk of addiction, there are other significant side effects - depressogennoe action, persistent violation of the cognitive (cognitive) functions, in particular, attention, concentration, memory, increased risk of falls (especially in elderly and senile), ataxia ; impact on driving, paradoxical reactions - excitement, euphoria and other symptoms of "behavioral toxicity"; withdrawal in the form of dysphoria, a sharp increase in anxiety, increased sympathetic tone, in severe cases - seizures and delirium [8.19].