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Dual action antidepressants like Effexor and Cymbalta are becoming
replacement agents if SSRI’s failed to achieve improvement
(remission). Remeron causes weight gain and sedation.

Anxiety Disorders
Generalized anxiety disorder can be difficult to diagnose due to its
prevalence and co-existence with other psychiatric conditions. Rapid
heart beat, sweaty palms, and feeling of losing one’s mind and losing
control are very common. Its is common for non-Caucasians to
experience anxiety as somatic complaints, e.g. headaches, backaches,
stomachache, and even painful menses. Typically, an internist is able
to rule physical causes of such presentations. Its is important to know
how your patient thinks of anxiety since it is so variable.

PTSD (post-traumatic stress disorder) became widely known as a
result of traumatic exposure during the Vietnam War, and later
subsequent wars. Currently it is used to describe the after effects of
any exposure to a serious trauma, including child abuse and sexual
exploitation. The hallmark of this condition is hyper arousal, i.e., an
increase symptoms anxiety, feelings of worthlessness and has pending
doom. Depression is almost always present, but can be masked by
frank anxiety and restless. Other anxiety disorders can also present in
the same individual. Adults and children respond best to
antidepressants in combination with support, group and individual
therapy.

Obsessive-compulsive disorder is best described by “As good as it
gets” movie where the actor has a need to repeat thoughts and actions
to help control anxiety and a sense of loss of control. This condition is
underreported due to the embarrassment of the patient, but usually
admitted to upon inquiry. Depression can result from this condition
due to its limiting and isolating results, but minor forms exists in
successful and well-know individuals. Medication and behavioral
techniques alone are equally effective, but best results are achieved
when combined.

Benzodiazepines, like Ativan, Klonopin, Xanax, Valium and Librium
are very effective anti-anxiety agents for the short-term treatment of