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Health Guide / Stress and anxiety

Anxiety treatments: therapies, medication, self-care

steve silvestro

Reviewed by Steve Silvestro, MD, written by Tobi Ash, MBA, RN, BSN

Last updated: Jun 04, 2021
10 min read

table of contents

  1. What is anxiety?
  2. What are the types of anxiety disorders?
  3. How can I treat my anxiety?
  4. Psychotherapy for anxiety
  5. Prescription medications to treat the symptoms of anxiety
  6. Other treatments for anxiety 
  7. Can my anxiety be cured forever?

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Many people have questions about anxiety treatments. What works best? Are there specific treatments for different types of anxiety disorders? Do you need to see a healthcare professional, or could you just wing it? 

These are all great questions! Here’s the scoop: Anxiety doesn’t usually get better on its own. It’s important to treat anxiety, especially if you’ve had symptoms for more than six months. Keep reading to get all the information you need about anxiety treatment. 

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What is anxiety?

Anxiety is a feeling of intense fear, nervousness, or worry about a situation. Many people feel anxious before going to school, work, or speaking in front of an audience. This type of anxiety is normal. It’s usually short-term, and the feelings disappear once the situation is over.

Some people keep having feelings of anxiety even after the stressful event is over, though. When you feel anxiety symptoms for more than six months, you may want to visit your primary care or mental health professional (Chand, 2020).

Living with anxiety can be exhausting. Anxiety disorders are one of the most common psychiatric and mental health conditions. Some people start treating themselves with self-care stress management and relaxation techniques and get support from loved ones or family members. However, for some people, this may not be enough.

Even if you’ve already been diagnosed with one anxiety disorder, there can be several causes and underlying medical conditions that increase your anxiety symptoms. Treatments are available to help you manage your anxiety disorder. Your healthcare provider should customize treatments to you; what works for someone else may not work for you. 

Types of anxiety disorders

There is no single cause for anxiety. Your genetics, environment, personality, and health all play a role in how you respond to stress.

Our bodies react to potentially dangerous situations with a “fight-or-flight” reaction. This reaction floods your body with hormones to help you manage the frightening situation. Anxiety disorders happen when you can’t switch off negative thoughts and your stress reaction. Treatments for symptoms of anxiety and anxiety disorders work in different ways to address all these aspects. 

There are several different types of anxiety disorders—they all share this fight-or-flight hormonal response, but each has its own characteristics.

Specific phobia

People with phobias are frightened by particular objects, activities, or situations. Claustrophobia (fear of small spaces) and agoraphobia (scared to leave the house) are two common examples of phobias. Phobias are among the most common anxiety disorders, and treatment usually involves exposure therapy (Samra, 2020).

Social anxiety disorder

Social anxiety disorder or social phobia is when people have anxiety or fear about social situations. They may feel they will be judged harshly or be humiliated when they’re around people. Treatments include medications and therapy (Rose, 2021).

Separation anxiety disorder

Separation anxiety disorder (SAD) is typical for children up to age three. Older children and adults often have separation anxiety disorder with other anxiety disorders, particularly panic disorder in adults. Psychotherapy is the treatment of choice (Feriante, 2021). 

Generalized anxiety disorder

Generalized anxiety disorder (GAD) happens when extreme worry impacts a person’s daily activities. GAD is linked with depression—many people are diagnosed with both. Treatment includes both psychotherapy and medications (Munir, 2021). 

Panic disorder

Panic disorder is when a person keeps having unpredictable panic attacks, usually with no warning. Panic disorder and panic attacks are both anxiety disorders but considered separate mental illnesses (Cackovic, 2020).

Panic attacks can have frightening physical symptoms like shortness of breath, chest pain, muscle tension, and nausea. People can also have emotional symptoms where they may feel they are dying (Cackovic, 2020).

Treatments for panic disorder include having a complete exam to rule out any underlying health condition that can cause these physical symptoms. If the health condition is treated and symptoms remain, treatment protocols include psychotherapy and medications (Cackovic, 2020). 

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is when a person obsesses or constantly thinks about an action or an object that leads to compulsive or repetitive behaviors. For example, some people with OCD are frightened of germs and may wash their hands repeatedly, even to the point where it damages their skin. These obsessions can interfere with daily life activities, including work or social situations. Treatments for OCD include medications, talk therapy, and brain/nerve stimulation devices (Brock, 2020).

How can I treat my anxiety?

The mainstays of treatment for anxiety are therapy and medication. There are some outside-the-box therapies as well, if your anxiety is resistant to the standard treatments. 

Psychotherapy for anxiety

There are several treatment options for anxiety disorders. You will need a licensed mental health professional—a psychologist or psychiatrist—to help you develop a treatment plan that works for you. Most therapists see their clients in one-on-one sessions or group therapy (Health Quality Ontario, 2017). 

You can benefit from psychotherapy by seeing your therapist in person or online (Eilert, 2021).

Cognitive-behavioral therapy

One of the most effective therapies for treating the symptoms of anxiety disorders is cognitive-behavioral therapy (CBT). CBT helps you identify what triggers your anxiety and teaches you tools and skills to change your reaction to fearful or anxiety-provoking situations.

CBT therapists can modify standard cognitive-behavioral therapy by adding other types of therapy for other anxiety disorders. Cognitive-behavioral therapy is appropriate for all anxiety disorders (Health Quality Ontario, 2017; Eilert, 2021).

Exposure therapy

If you suffer from phobias, your CBT therapist may recommend exposure therapy. Exposure therapy is where the therapist gradually exposes you to the anxiety-provoking object or activity in a safe and controlled way. This process often starts with imagery and progresses to the actual feared activity or object.

An example is where a person is afraid to leave the house (agoraphobia). At first, the CBT therapist might have them imagine opening the front door. With every session, the person gets more exposure to all of the potential aspects of finally leaving the house. The overall goal is to eliminate the fear and anxiety related to the phobia. Exposure therapy is appropriate for phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Prescription medications to treat the symptoms of anxiety

The U.S. Food and Drug Administration (FDA) regulates the medications used to treat anxiety disorders. Your primary care healthcare provider can prescribe these medications if you need them. But suppose your symptoms of anxiety are severe or aren’t responsive to your current treatment plan. In that case, your primary care provider may refer you to a psychiatrist to help manage your care with medication (Bandelow, 2017, Carl, 2020).

The medications used to treat anxiety work on hormones, neurotransmitters, and chemical messengers in your body. These include serotonin, norepinephrine, GABA, and epinephrine (Sartori, 2019). 

The most common medications prescribed for anxiety disorders are antidepressants. While their original purpose was to help relieve depression, they help ease anxiety as well. There are several types of antidepressants, so if one doesn’t work for you, your healthcare provider may prescribe another. 

Antidepressants for anxiety

Antidepressants used for anxiety disorder are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Serotonin is a neurotransmitter that helps regulate your mood. People with anxiety disorder often have trouble with mood symptoms like feeling worried, frightened, irritable, or unable to sleep. These medications help increase serotonin levels in your brain so you can start feeling better (Bandelow, 2017; Sartori, 2019; Carl, 2020).

SSRIs usually prescribed for anxiety disorders include fluoxetine (Prozac; see Important Safety Information), paroxetine (Paxil), and sertraline (Zoloft; see Important Safety Information). Other common SSRIs are citalopram (Celexa) and escitalopram (Lexapro; see Important Safety Information). SSRIs treat generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD) (Bandelow, 2017; Sartori, 2019; Carl, 2020).

SNRIs work similarly to SSRIs by increasing serotonin and limiting the effects of norepinephrine, a stress chemical, on the brain. SNRIs usually prescribed for anxiety disorders include duloxetine (Cymbalta; see Important Safety Information) and venlafaxine (Effexor; see Important Safety Information). SNRIs treat panic disorder, generalized anxiety disorder, and social anxiety disorder (Bandelow, 2017; Sartori, 2019; Carl, 2020).

Researchers are looking into how newer antidepressants, like mirtazapine (Remeron; see Important Safety Information) and vilazodone (Viibryd), may impact GAD. There are also some promising results from an older antihistamine called hydroxyzine (Atarax; see Important Safety Information). While results are encouraging, more extensive studies are needed (Strawn, 2018).

Benzodiazepines

Benzodiazepines help increase the effect of GABA in your brain. GABA is an amino acid that helps you relax and sleep by lowering anxiety. Benzodiazepines are often prescribed as an anti-anxiety medication. Since they are highly addictive, many healthcare professionals try to limit these to short-term management of anxiety disorders.

Common benzodiazepines prescribed for symptoms of anxiety include lorazepam (Ativan), clonazepam (Klonipin), and alprazolam (Xanax). These treat generalized anxiety disorder, panic disorder, and social anxiety disorder (Bandelow, 2017; Sartori, 2019; Carl, 2020).

Beta-blockers

Beta-blockers are typically used to treat heart problems like high blood pressure. They work by blocking epinephrine—better known as adrenaline. Epinephrine is a hormone that increases your heart rate and blood pressure, and beta-blockers decrease those effects.

Beta-blockers are best for people with physical symptoms of anxiety, like a pounding or racing heart. Low doses of propranolol (Inderal) and atenolol (Tenormin) are prescribed for people with performance anxiety (Bandelow, 2017; Sartori, 2019; Carl, 2020).

Other treatments for anxiety 

If you are diagnosed with generalized anxiety disorder only, your primary care provider or psychiatrist may prescribe buspirone (Buspar). This medication works best for this type of anxiety disorder (Bandelow, 2017, Sartori, 2019).

Some mental health providers may use older medications like tricyclic antidepressants or monoamine oxidase inhibitors. These medications are generally used to treat depression but may also help treat the symptoms of anxiety disorders (Bandelow, 2017; Sartori, 2019).

Ketamine

The FDA approved ketamine, an anesthetic drug usually used for surgical procedures, for depression. This drug is generally given via muscular injection or IV, though it’s now also available in a nasal spray, called esketamine. Some healthcare providers provide ketamine to people with severe anxiety disorders, especially OCD, PTSD, and SAD (Ballard, 2020). 

Medicinal cannabis

There are very few evidence-based studies on medical cannabis (marijuana). However, there are anecdotal reports on its effects on anxiety. A small amount of research shows that medical cannabis may be effective for social anxiety disorder (Sarris, 2020).

Brain and nerve therapies

People who suffer from severe anxiety disorders that do not respond to psychotherapy or prescription medication may try brain stimulation therapy. These therapies work on the parts of the brain that impact fear, mood, and stress responses. Most of these therapies are helpful for OCD, but there is some evidence that they can help treat panic disorders, too (Cirillo, 2019).

The most invasive of brain stimulation therapies is deep brain stimulation. The process of deep brain stimulation is similar to a heart pacemaker, in that an electrode is placed in the brain to control a person’s mood. Because this procedure is so invasive, it is currently reserved for extremely severe OCD (Cirillo, 2019).

Another form of brain stimulation is called repetitive transcranial magnetic stimulation (rTMS). It consists of electrodes being placed on the scalp rather than inside the head. This type of stimulation sends magnetic pulses to the brain to help with difficult-to-treat OCD. There are promising results of rTMS research for panic disorder, social anxiety disorder, and post-traumatic stress disorder (Guo, 2017).

Other transcranial (or scalp electrode) therapies currently being researched for anxiety disorders include transcranial direct current stimulation (tDCS) and transcranial electrical stimulation (tES) (Guo, 2017).

An older therapy best known for treating mania and depression since the 1930s, electroconvulsive therapy (ECT), is also being researched for generalized anxiety disorder, social anxiety disorder, OCD, and PTSD (Guo, 2017).

Another type of stimulation is vagus nerve stimulation. The vagus nerve starts from the head, travels down to the abdomen, and is connected to many areas in the brain. The FDA has approved vagus nerve stimulation to treat depression and epilepsy.

With vagus nerve stimulation, a small device is implanted on the left side of the chest. A thin wire is then attached to the vagus nerve, a major nerve in the body. A non-invasive vagus nerve stimulation device recently received approval from the FDA for cluster headaches only. Several studies are in progress to see if these work for all anxiety disorders (Carreno, 2017).

Complementary treatments

Some people want to try a more natural approach to treating their anxiety. Complementary or alternative providers typically don’t use prescription medications. Instead, they often suggest supplements or herbal remedies. 

The FDA does not regulate herbal remedies and supplements, and there is little scientific research on their safety and effectiveness. Just because they’re “natural,” that doesn’t mean they’re automatically safe. It’s important to let your mental health professional or primary care provider know if you are taking anything besides your prescribed medications. Some herbal supplements may interact poorly with your prescriptions.

The only supplements that show some positive results in reputable studies are lavender and kava. More research is needed to determine if other herbs and supplements work for anxiety (Strawn, 2019).

Can my anxiety be cured forever?

Treating anxiety takes time—no matter which approaches you use. In some cases, it may take 6–8 weeks to see some results. If you have adverse side effects from your treatment plan, let your mental health provider know as soon as possible. Do not stop taking your medication without speaking to your healthcare provider first. Stopping therapy or medicine suddenly can cause other health problems.

Several factors cause anxiety; some you can control, like lowering your stress levels, and others you can’t, like your genetics. If your anxiety disorder has a genetic component, it may not be possible to cure your anxiety forever. However, psychotherapy, medications, and self-help strategies can help you manage the intense fear, worry, and other anxiety symptoms.

When you work with your healthcare provider to find the best treatment plan for you—and you follow that treatment plan—you will be able to get back to enjoying your life.

References

  1. Ballard, E. D., & Zarate, C. A., Jr (2020). The role of dissociation in ketamine’s antidepressant effects. Nature Communications, 11(1), 6431. doi: 10.1038/s41467-020-20190-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755908/
  2. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. doi: 10.31887/DCNS.2017.19.2/bbandelow. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
  3. Brock, H., & Hany, M. (2020). Obsessive-compulsive disorder (OCD). StatPearls. Retrieved from: https://www.statpearls.com/ArticleLibrary/viewarticle/26069
  4. Cackovic, C., Nazir, S., & Marwaha, R. (2020). Panic disorder (attack). StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/26587
  5. Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., et al. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1–21. doi: 10.1080/16506073.2018.1560358. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063818/
  6. Carreno, F. R., & Frazer, A. (2017). Vagal nerve stimulation for treatment-resistant depression. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 14(3), 716–727. doi: 10.1007/s13311-017-0537-8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509631/
  7. Cirillo, P., Gold, A. K., Nardi, A. E., Ornelas, A. C., Nierenberg, A. A., Camprodon, J., & Kinrys, G. (2019). Transcranial magnetic stimulation in anxiety and trauma-related disorders: A systematic review and meta-analysis. Brain and Behavior, 9(6), e01284. doi: 10.1002/brb3.1284. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6576151/
  8. Chand, S. P., Marwaha, R., & Bender, R. M. (2021). Anxiety (nursing). StatPearls. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/17728
  9. Eilert, N., Enrique, A., Wogan, R., Mooney, O., Timulak, L., & Richards, D. (2021). The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis. Depression and Anxiety, 38(2), 196–219. doi: 10.1002/da.23115. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894171/
  10. Feriante, J., & Bernstein, B. (2020). Separation anxiety. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/28899
  11. Guo, Q., Li, C., & Wang, J. (2017). Updated review on the clinical use of repetitive transcranial magnetic stimulation in psychiatric disorders. Neuroscience Bulletin, 33(6), 747–756. doi: 10.1007/s12264-017-0185-3. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725388/
  12. Health Quality Ontario (2017). Psychotherapy for major depressive disorder and generalized anxiety disorder: A health technology assessment. Ontario Health Technology Assessment Series, 17(15), 1–167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709536/
  13. Munir, S., Gondal, Z., & Takov, V. (2017). Generalized anxiety disorder (GAD). StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/22130
  14. Rose, G. M., & Tadi, P. (2021). Social anxiety disorder. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/29183
  15. Samra, C. K., & Abdijadid, S. (2020). Specific phobia. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/29262
  16. Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry, 20(1), 24. doi: 10.1186/s12888-019-2409-8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966847/
  17. Sartori SB, Singewald N. (2019). Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacology & Theraputics. 204:107402. doi: 10.1016/j.pharmthera.2019.107402. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31470029/
  18. Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. doi: 10.1080/14656566.2018.1491966. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340395/
steve silvestro
Steve Silvestro, MD

Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.

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Important Safety Information for Fluoxetine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What is the FDA-approved use of fluoxetine?

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for acute and maintenance treatment of Major Depressive Disorder (MDD).

Who should not use fluoxetine?

Do not use fluoxetine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide or thioridazine. Taking these medications with fluoxetine can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.

How should I take fluoxetine?

You can take fluoxetine with or without food. 

You should take fluoxetine exactly as prescribed, and continue to take fluoxetine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking fluoxetine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using fluoxetine?

  • Fluoxetine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Benzodiazepines, such as diazepam and alprazolam
    • Other or SSRIs or SNRIs, such as sertraline (Zoloft)
    • Tamoxifen
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Family history of Bipolar Disorder or family history of suicide
    • Seizures
    • Irregular heartbeat or heart issues
    • Bipolar Disorder
    • Glaucoma or eye problems
    • Diabetes
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if fluoxetine should be used during pregnancy. There have been reports of fluoxetine passing into breast milk. Talk to your provider about the best way to feed your baby while taking fluoxetine.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking fluoxetine?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with fluoxetine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when fluoxetine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Allergic Reactions and Rash: Tell your provider if you develop a rash or hives. Discontinue use of fluoxetine and seek emergency care immediately if you have a severe allergic reaction. Signs and symptoms of a severe allergic reaction include swelling of the face, eyes, or mouth, or having trouble breathing. 
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Fluoxetine may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Cognitive and Motor Impairment: Fluoxetine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take fluoxetine.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.

What are the most common side effects of fluoxetine?

  • Nausea, diarrhea
  • Lack of appetite, weight loss
  • Dry mouth
  • Headache
  • Sexual problems, including decreased sex drive, erectile dysfunction, or trouble ejaculating
  • Change in sleep habits, including insomnia or increased sleepiness
  • Nervousness, anxiety
  • Lack of energy, or feeling generally weak
  • Tremor
  • Sweating

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Sertraline

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted. 

What is the FDA-approved use of sertraline?

Sertraline is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of Major Depressive Disorder (MDD).

Who should not use sertraline?

Do not use sertraline if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide. Taking this medication with sertraline can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
  • You have a known allergic reaction to sertraline.

How should I take sertraline?

You can take sertraline with or without food. 

You should take sertraline exactly as prescribed, and continue to take sertraline as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking sertraline without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using sertraline?

  • Sertraline has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Other SSRIs or SNRIs, such as fluoxetine (Prozac)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Liver problems
    • Irregular heartbeat or heart problems
    • Stroke
    • High blood pressure
    • Seizures
    • Glaucoma or eye problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if sertraline should be used during pregnancy or while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking sertraline?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with sertraline. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when sertraline is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Increased risk of bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Sertraline may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Cognitive and Motor Impairment: Fluoxetine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take sertraline.

What are the most common side effects of sertraline?

  • Nausea, loss of appetite, diarrhea, or indigestion
  • Increased sweating
  • Tremor or shaking
  • Agitation
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive
  • Feeling tired or fatigued
  • Anxiety

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Escitalopram

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of escitalopram?

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for:

  • Acute and Maintenance Treatment of Major Depressive Disorder (MDD) 
  • Acute Treatment of Generalized Anxiety Disorder (GAD)

Who should not use escitalopram?

Do not use escitalopram if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide. Taking this medication with escitalopram can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
  • You have a known allergic reaction to escitalopram.

How should I take escitalopram?

You can take escitalopram with or without food.

You should take escitalopram exactly as prescribed, and continue to take escitalopram as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking escitalopram without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using escitalopram?

  • Escitalopram has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft) or citalopram (Celexa)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Seizures
    • Heart problems
    • Glaucoma or eye problems
    • Liver problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if escitalopram should be used during pregnancy. There have been reports of escitalopram passing into breast milk. Talk to your provider about the best way to feed your baby while taking escitalopram.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking escitalopram?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with escitalopram. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when escitalopram is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Escitalopram may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • Cognitive and Motor Impairment: escitalopram may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while taking escitalopram.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.

What are the most common side effects of escitalopram?

  • Insomnia
  • Nausea, diarrhea
  • Increased sweating
  • Fatigue and drowsiness
  • Difficulty sleeping, insomnia
  • Headache
  • Decreased libido
  • Difficulty reaching orgasm, or abnormal ejaculation

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Duloxetine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of duloxetine?

Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SSRI) used for:

  • Acute and Maintenance Treatment of Major Depressive Disorder (MDD)
  • Generalized Anxiety Disorder (GAD)

Who should not use duloxetine?

Do not use duloxetine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. Taking an MAOI at the same time as duloxetine may increase the risk of serotonin syndrome.

How should I take duloxetine?

You can take duloxetine with or without food.

You should take duloxetine exactly as prescribed, and continue to take duloxetine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking duloxetine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using duloxetine?

  • Duloxetine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft) or citalopram (Celexa)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Liver problems
    • Heavy alcohol use
    • Kidney problems
    • Seizures
    • Heart problems
    • Glaucoma or eye problems
    • Diabetes
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. Use of duloxetine during the month before delivery may lead to an increased risk for postpartum hemorrhage. You should discuss with your provider if duloxetine should be used during pregnancy. There have been reports of duloxetine passing into breast milk. Talk to your provider about the best way to feed your baby while taking duloxetine.
    • There is a pregnancy exposure registry that monitors the pregnancy outcomes in women exposed to duloxetine during pregnancy. To enroll, contact the Cymbalta (duloxetine) Pregnancy Registry at 1-866-814-6975 or https://lillypregnancyregistry.com/ 

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking duloxetine?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with duloxetine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Liver Failure: Severe liver problems, sometimes fatal, have been reported with duloxetine. Talk to your provider if you develop itching, right upper belly pain, dark urine, or yellow skin/eyes, which may be signs of liver problems. Heavy alcohol consumption may be associated with severe liver injury.
  • Decrease in blood pressure when standing up, falls, and fainting: Monitor especially during the beginning of treatment and with any dose increases. Your provider may consider lowering your dosage.
  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when duloxetine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Duloxetine may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, and warfarin. A post-marketing study showed a higher incidence of postpartum hemorrhage in mothers taking duloxetine.
  • Severe Skin Reactions: These skin reactions may need to be treated in a hospital and may be life-threatening. Call your provider right away or get emergency help if you have skin blisters, peeling rash, sores in your mouth, hives, or any other allergic reactions.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.

What are the most common side effects of duloxetine?

  • Nausea, vomiting
  • Dry mouth
  • Change in sleep habits including increased sleepiness or insomnia
  • Constipation, diarrhea
  • Decreased appetite, weight loss
  • Increased sweating
  • Fast heartbeat
  • Agitation
  • Headache
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Venlafaxine Extended-Release

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of venlafaxine extended-release?

Venlafaxine extended-release is a serotonin and norepinephrine reuptake inhibitor (SNRI) for the treatment of:

  • Major Depressive Disorder (MDD)
  • Generalized Anxiety Disorder (GAD)

Who should not use venlafaxine extended-release?

Do not use venlafaxine extended-release if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You have a known allergic reaction to venlafaxine hydrochloride or desvenlafaxine succinate.

How should I take venlafaxine extended-release?

You should take venlafaxine extended-release with food.

You should take venlafaxine extended-release exactly as prescribed, and continue to take venlafaxine extended-release as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking venlafaxine extended-release without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using venlafaxine extended-release?

  • Venlafaxine extended-release has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs)
    • Tricyclic Antidepressants (TCAs)
    • NSAIDs, such as ibuprofen or naproxen
    • Aspirin
    • Blood thinners, such as warfarin (Coumadin)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft)
    • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Seizures
    • High blood pressure
    • High cholesterol
    • Heart problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI or SNRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if venlafaxine extended-release should be used during pregnancy. Some venlafaxine extended-release may pass into breast milk. Talk to your provider about the best way to feed your baby while taking venlafaxine extended-release.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking venlafaxine extended-release?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with venlafaxine extended-release. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when venlafaxine extended-release is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Increases in blood pressure: Your blood pressure should be well controlled prior to starting treatment. Your provider will monitor your blood pressure regularly. Consider monitoring your blood pressure at home.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Venlafaxine extended-release may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, warfarin, and other anticoagulants.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Cognitive and Motor Impairment: Venlafaxine extended-release may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take venlafaxine extended-release.
  • Lung Disease and Inflammation (Pneumonitis): Venlafaxine extended-release may cause rare lung problems. Monitor for symptoms such as worsening shortness of breath, cough, or chest discomfort.

What are the most common side effects of venlafaxine extended-release?

  • Nausea, vomiting
  • Change in sleep habits including increased sleepiness or insomnia
  • Dry mouth
  • Sweating
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive
  • Decreased appetite, weight loss
  • Constipation
  • Abnormal dreams
  • Headache
  • Dizziness
  • Nervousness
  • Tremor

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Mirtazapine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What is the FDA-approved use of mirtazapine?

Mirtazapine is used to treat Major Depressive Disorder (MDD).

Who should not use mirtazapine?

Do not use mirtazapine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. When MAOIs are used at the same time as mirtazapine, it may increase the risk of serotonin syndrome.
  • You have a known allergic reaction to mirtazapine.

How should I take mirtazapine?

You can take mirtazapine with or without food. 

You should take mirtazapine exactly as prescribed, and continue to take mirtazapine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking mirtazapine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using mirtazapine?

  • Mirtazapine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
    • Tricyclic Antidepressants (TCAs)
    • Migraine medications called triptans, such as sumatriptan (Imitrex)
    • SSRIs or SNRIs, such as fluoxetine (Prozac)
    • St. John’s Wort
    • Warfarin (Coumadin)
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide
    • Bipolar Disorder
    • Family history of Bipolar Disorder or family history of suicide
    • Seizures
    • Irregular heartbeat or heart problems
    • High cholesterol or triglyceride levels
    • Liver problems
    • Kidney problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if mirtazapine should be used during pregnancy and while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking mirtazapine?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with mirtazapine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Decreased levels of a type of white blood cell (agranulocytosis): Mirtazapine may put you at risk for a condition that prevents your body from fighting off infections. If you experience fever, chills, sore throat, mouth sores, or flu-like symptoms, you should stop taking mirtazapine and contact your provider. 
  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when mirtazapine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Feeling sleepy or drowsy: Mirtazapine may make you drowsy or sleepy so taking it in the evening prior to sleep is recommended. Talk to your provider about the best time to take mirtazapine. 
  • Cognitive and Motor Impairment: Mirtazapine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. You should avoid alcohol while taking mirtazapine.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Increased Levels of Phenylalanine: For patients with phenylketonuria (PKU), it is important to note that mirtazapine contains phenylalanine. If you have PKU, review mirtazapine doses and effects on total phenylalanine ingestion levels with your healthcare provider.

What are the most common side effects of mirtazapine?

  • Sleepiness
  • Increased appetite
  • Weight gain
  • Dizziness
  • Dry mouth

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information. 

Important Safety Information for Hydroxyzine

What is the FDA-approved use of hydroxyzine?

Hydroxyzine is an antihistamine indicated for the treatment of anxiety. Your Ro-affiliated provider may recommend the use of hydroxyzine as an add-on treatment for major depressive disorder (MDD).

Who should not use hydroxyzine?

Do not use hydroxyzine if:

  • You are pregnant, planning to become pregnant, or breastfeeding.
  • You have a heart rhythm disorder called Long QT syndrome.
  • You have a known allergic reaction to hydroxyzine.

How should I take hydroxyzine?

You can take hydroxyzine with or without food. Use caution when drinking alcohol because hydroxyzine may increase the effects of alcohol.

You should take hydroxyzine exactly as prescribed, and continue to take hydroxyzine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking hydroxyzine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using hydroxyzine?

  • Hydroxyzine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
    • Antiarrhythmics, such as amiodarone sotalol, procainamide, or quinidine
    • Antipsychotics, such as ziprasidone (Geodon) or quetiapine (Seroquel)
    • Antidepressants, such as isocarboxazid or tranylcypromine
    • CNS depressants, such as diazepam (Valium), alprazolam (Xanax), zolpidem (Ambien), or phenobarbital (Luminal)
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
    • Suicidal thoughts or attempted suicide or family history of suicide
    • Bipolar Disorder or family history of Bipolar Disorder 
    • Irregular heartbeat or heart problems

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking hydroxyzine?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with hydroxyzine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Cognitive and Motor Impairment: Hydroxyzine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. 
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Skin Reactions: Hydroxyzine may cause a condition called acute generalized exanthematous pustulosis. Tell your provider immediately if you notice the sudden appearance of pustules or blisters anywhere on your body (including in your mouth).

What are the most common side effects of hydroxyzine?

  • Dry eyes, skin, and mouth
  • Drowsiness, feeling tired or fatigued
  • Headache
  • Nausea, change in appetite, constipation

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.