Лікарські препарати для тривалого лікування тривожності та пов'язаних із нею розладів*

* The medications listed are used clinically for all the anxiety disorders, OCD, and depression. FDA approval has been obtained for some conditions; the lack of FDA approval for other conditions is due to a lack of sufficient studies. There is no evidence that one SSRI is better than or not as effective as the others (Varigonda AL, Jakubovski E, Taylor MJ, et al: Systematic review and meta-analysis: Early treatment responses of selective serotonin reuptake inhibitors in pediatric major depressive disorder. J Child Adolescent Psychopharmacol 54(7):557-564, 2015. doi: https://doi.org/10.1016/j.jaac.2015.05.004).

† Unless otherwise stated, dose is given once a day. Starting dose is increased only if needed. Dose ranges are approximate. Interindividual variability in therapeutic response and adverse effects is considerable. When stopping a medication, taper gradually by 25% weekly. This table is not a substitute for the full prescribing information. Behavioral adverse effects (eg, disinhibition, agitation) are common but are usually mild to moderate. Usually, decreasing the dose or changing to a different medication eliminates or reduces these effects. Rarely, such effects are severe (eg, aggressiveness, increased suicidality). Behavioral adverse effects are idiosyncratic and may occur with any antidepressant and at any time during treatment. As a result, children and adolescents taking such medications must be closely monitored.

‡ Genetic testing for enzymes that metabolize the SSRIs have shown interindividual differences in pharmacokinetic parameters and treatment outcomes associated with CYP2D6 and CYP2C19 polymorphisms. The CPIC (Clinical Pharmacogenetics Implementation Consortium) guidelines indicate poor response for CYP2C19 and D26 rapid metabolizers and risk for adverse effects for poor metabolizers, recommending starting at 50% of the recommended dose. Ethnic variations show that 7 to 15% of White, 2% of Asian, and 2% of African Americans lack the gene for 2D6 while 10% of White people and 50% of Asians have genetic variants that reduce 2D6 function (Droll K, Bruce-Mensah K, Otton SV: Comparison of three CYP2D6 probe substrates and genotype in Ghanaians, Chinese and Caucasians. Pharmacogenetics 8(4)325-333, 1998. doi: 10.1097/00008571-199808000-00006). As newly discovered genetic variants and copy number variants get incorporated into the CYP2D6 biomarker panels, predictions of metabolizer status will become more accurate. (For the former, see Ray B, Ozcagli E, Sadee W, et al: CYP2D6 haplotypes with enhancer SNP rs5758550 and rs16947 (*2 allele): Implications for CYP2D6 genotyping panels. Pharmacogenet Genomics 29(2):39-47, 2019.) doi: 10.1097/FPC.0000000000000363; for the latter, see Beoris M, Wilson JA, Garces JA, et al: CYP2D6 copy number distribution in the US population. Pharmacogenet Genomics 26(2):96-99, 2016. doi: 10.1097/FPC.0000000000000188. Clinicians who order these tests need to help families interpret the results.

§ Fluoxetine and paroxetine are potent inhibitors of the liver enzymes that metabolize many other drugs (eg, beta-blockers, clonidine, lidocaine).

¶ Strawn JR, Prakash A, Zhang Q, et al: A randomized, placebo-controlled study of duloxetine for the treatment of children and adolescents with generalized anxiety disorder. J Am Acad Child Adolesc Psychiatry 54(4):283-293, 2015. doi: 10.1016/j.jaac.2015.01.008.

CPIC = Clinical Pharmacogenetics Implementation Consortium; FDA = Food and Drug Administration; GAD = generalized anxiety disorder; OCD = obsessive compulsive disorder; SNRI = serotonin-norepinephrine reuptake inhibitors; SSRI = selective serotonin reuptake inhibitor