Antidepressants (SSRIs, TCAs, and SNRIs)
Antidepressants are the most commonly prescribed medication for hypochondriasis, especially if there is comorbidity with other mental disorders. Selective serotonin reuptake inhibitors (SSRIs) tend to be the most effective in treating the symptoms associated with hypochondriasis and have fewer side effects than other antidepressants.
SSRIs alleviate the symptoms of depression by altering the neurotransmitters, which are chemical messengers that the brain uses to communicate between its cells. SSRIs block the reabsorption – known as reuptake – of serotonin, a neurotransmitter in the brain that affects mood. Adjustments in serotonin levels appear to help brain cells send and receive chemical messages more efficiently, which can lead to improved mood. SSRIs appear to only have an effect on serotonin, and not other neurotransmitters, which is why they are called selective. Commonly prescribed SSRIs for hypochondriasis include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Serotonin norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs, but affect two neurotransmitters – serotonin and norepinephrine. Norepinephrine helps control how the body responds to stress by regulating heart rate, blood pressure and sugar levels. Low levels of norepinephrine can suppress normal mental and emotional functions, leading to depression-like symptoms. SNRIs are reported to be more effective than SSRIs in treating symptoms, but the side effects can be more severe. Venlafaxine (Effexor XR) is the most often prescribed SNRI for treating hypochondriasis.
Tricyclic antidepressants (TCAs) such as clomipramine (Anafranil) and imipramine (Tofranil), also affect serotonin and norepinephrine, but they have considerably more side effects than SSRIs and SNRIs because they affect other neurotransmitters in the brain. They are recommended for use if other antidepressants fail to relieve the patient’s symptoms.
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