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While SSRIs can have an immediate effect, the full effect can take anywhere from 3-8 weeks (even longer sometimes) depending on the person. It is completely legal and ethical to use medications for off-label purposes, but ideally the patient and provider should have a discussion about this first. Pharmacy companies do not always bother pursuing FDA approvals due to cost reasons and the realization that the meds will be used off-label. While not all SSRIs have this many FDA approved indications, we often use the other ones for the same conditions. Sertraline is FDA approved for multiple conditions including: Major Depression, OCD, PTSD, Social Anxiety, Panic Disorder, and Premenstrual Dysphoric Disorder. They are technically classified as antidepressants (which is a poor and oversimplified classification, but we don’t yet have a new and better system).
They tend to be the first line choice for multiple anxiety disorders and depression. These include fluoxetine (aka Prozac), paroxetine (aka Paxil), sertraline (aka Zoloft), fluvoxamine (aka Luvox), citalopram (aka Celexa), and escitalopram (aka Lexapro). In our experience, those relying on medications only may be more likely to experience tolerance to medications over time. The decision of which medicine should be tried should always be made after a complete in person evaluation, which this blog is not meant to supplant. Keep in mind that while medicines can be helpful for many, it is important to always stress the need for a holistic treatment plan including (but not limited to) psychotherapy, exercise, nutrition, mindfulness training, work life balance, social support, and so on. The topics we are going to touch on in this post are: 1) which classes are useful for which types of anxiety disorders, 2) general pros and cons of each class, and 3) basic mechanisms of action of each group. Obviously, the point of this post is breadth rather than depth, and there is so much more to say about any one of the categories mentioned here - but we hope that this will provide a helpful overview for patients and will help them feel more prepared when walking into a prescriber’s office. One thing that’s not clear to most patients is that there is a huge number of different medications that can be used to treat anxiety.
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