Paroxetine in the treatment of anxiety and depressive disorders in somatic patients

Anxiety is an integral part of the clinical picture of mental, neurological and somatic disorders. Being a clinical phenomenon of psychopathological manifestations, it is closely related to other symptoms and, as a rule, to the greatest degree determines the level of psychosocial maladaptation.

Central to a series of anxiety-phobic disorders is panic disorder. Over the course of a lifetime, 10-20% of the population will experience one or more panic attacks. Panic attacks – an unexpectedly arising and quickly, within a few minutes, growing symptom complex of vegetative disorders (vegetative crisis – palpitations, chest tightness, a feeling of suffocation, lack of air, sweating, dizziness), combined with a feeling of impending death, fear of loss of consciousness, loss of control above oneself. The duration of panic attacks is variable, with an average of about 30 minutes. In 2.7% of the population, panic attacks are combined with agoraphobia. Social phobias (fear of shame and confusion in the presence of other people) affect 3-5% of the population. Specific phobias (fear of certain diseases, specific objects, situations, actions) are more common than social ones; patients, according to various sources, comprise 5-12% of the population. Generalized anxiety disorder occurs in 2-5% of the population. These people become disabled very quickly, and in most cases they do not immediately fall into the field of vision of psychiatrists, moving from a local doctor to a neuropathologist and other specialists. In the beginning, the diagnosis of vegetative-vascular dystonia is most often made, then diencephalic crises.

According to our data, the incidence of clinically significant depression among inpatient therapeutic patients is 31.5%, depressive disorders are divided into three groups: psychogenic – 46.1%, somatogenic – 36.4%, endogenous – 17.5%. At the same time, about 35% of patients in outpatient practice with unclear somatic diagnoses also suffer from larvae (somatized) depression.

Somatized depression, disguised as somatovegetative disorders, often lead to errors in diagnosis. Deterioration of the patient’s mental state, markedly reducing stress tolerance, leads to deterioration of the somatic state and, accordingly, improper treatment of the patient.

The adaptive role of anxiety is characterized by a number of physiological shifts that prepare the body for a quick response to danger: the release of adrenaline increases, the sympathetic system is activated, resulting in an increase in blood pressure, an increase in blood flow in the muscles and brain, and blood glucose levels increase in order to create the most favorable for these systems. conditions for activity.

These and other physiological changes are clearly adaptive in nature, but they, with excessive strength and duration, can be the cause of somatic disasters and diseases: heart attack, stroke, hypertensive crisis.

Given the nature of neuroendocrine reactions, anxiety can be defined as a mental component of stress. An inadequately severe anxious reaction to a traumatic situation can occur if the person has a low threshold for anxious response. A possible reason for this may be the insufficient activity of the GABA-ergic system and, in particular, the GABA-benzodiazepine receptor complex. In another type of anxiety disorder, panic attacks, patients have a reduced GABA content in the occipital lobe of the cerebral cortex (A. Goddard et al., 2001) and there is a genetically determined change in benzodiazepine receptors. This is why benzodiazepine tranquilizers are not effective enough in treating panic disorder.

The drugs of choice in these cases are selective serotonin reuptake inhibitors (SSRIs). SSRIs – a group of drugs that are heterogeneous in chemical structure. These are one-, two- and multicyclic drugs with a common mechanism of action: they selectively block the reuptake of serotonin only, without affecting the uptake of norepinephrine and dopamine,
and do not affect the cholinergic and histaminergic systems. The true “champion” in serotonin-positive effect is paroxetine, which has the most balanced effect. The advantage of paroxetine, compared with tricyclic antidepressants, which are most often used by general practitioners, is its safety for patients with somatic and neurological pathology, the elderly. Paroxetine can also be used on an outpatient basis.

An increasing amount of data shows that paroxetine, as a dual-action drug (anxiety and depression), has inherited high efficacy and good tolerance (minimum side effects) from previous generations of antidepressants, it acts against a wider range of symptoms of anxiety and depression.

The mechanism of action of paroxetine is based on its ability to selectively block the reuptake of serotonin (5HT) by the presynaptic membrane, which is associated with an increase in the free content of this neurotransmitter in the synaptic cleft and an increase in the serotonergic effect in the central nervous system, which is responsible for the development of the thymoanaleptic (antidepressant) effect. Paroxetine has low affinity for m-cholinergic receptors, a- and b-adrenergic receptors, as well as for dopamine, 5HT1-like, 5HT2-like and histamine H1 receptors.
The main components of the profile of the psychotropic activity of paroxetine are antidepressant and anti-anxiety effects with a moderate stimulating (activating) effect. In the series of serotonergic drugs, paroxetine is the most powerful and one of the most specific serotonin reuptake blockers.

Paroxetine has therapeutic efficacy even in those patients who did not respond adequately to previous standard therapy. The patient’s condition improves within 1 week after the start of treatment. Taking paroxetine in the morning does not adversely affect the quality and duration of sleep. Moreover, with effective therapy, sleep should improve. During the first few weeks of taking paroxetine, it improves the condition of patients with anxiety or depressive disorders of various origins. Paroxetine has minimal side effects. Treatment with paroxetine is characterized by low severity and rarity of unwanted symptoms, which determines the good tolerance of the drug and the willingness of patients to take paroxetine for a long time as maintenance therapy.

Thus, we can say that, having a pronounced thymoanaleptic effect, paroxetine is a balanced antidepressant and equally reduces both symptoms of anxiety and lethargy.

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