An Open-Label Study to Evaluate Switching from an SSRI or SNRI to Tiagabine to Alleviate Antidepressant-Induced Sexual Dysfunction in Generalized Anxiety Disorder

Abstract

Tiagabine may be useful in subjects who respond to previous antidepressant therapy but develop sexual dysfunction as an adverse event.

A PET Study of Tiagabine Treatment Implicates Ventral Medial Prefrontal Cortex in Generalized Social Anxiety Disorder

“…Open-labeled trials have demonstrated modest support for the efficacy and tolerability of tiagabine for SAD and other anxiety disorders. This support is garnered from studies predating the onset of the present study (Crane, 2003;Rosenthal, 2003;Ninan and Papp, 2004) as well as in more recent studies (Dunlop et al, 2007;Schwartz et al, 2007). The principal objective of the present 18 FDG-PET study was to test the following hypotheses as related to a model of corticolimbic dysfunction in gSAD: (1) compared to HC subjects at pretreatment, gSAD patients would exhibit greater regional cerebral metabolic rate of glucose (rCMRglu) uptake in limbic medial temporal lobe regions and lower rCMRglu uptake in ventral prefrontal regions, (2) compared to pretreatment, gSAD patients would demonstrate decreased rCMRglu in limbic medial temporal lobe regions and increased rCMRglu within ventral prefrontal regions following treatment, and (3) the cerebral metabolic profile within these corticolimbic regions of gSAD patients at pretreatment would serve as a predictor of tiagabine treatment response.…”

“…The pathophysiology underlying SAD is poorly understood. Thus, studies aimed at improving our understanding of the pathophysiology of SAD and treatment-related functional changes are of great clinical importance, particularly given the efficacy limitations and side-effect profiles associated with current pharmacotherapy for gSAD (Pollack, 2001;Schwartz et al, 2007).…”

Tiagabine in anxiety disorders

“…A recent study investigated tiagabine monotherapy in patients with GAD who had been switched from SSRIs or SNRIs as a result of antidepressant-induced sexual dysfunction [38]. All patients had achieved an adequate therapeutic response (defined as ≥ 50% decrease in HAM-A score) to their previous medication and were switched to tiagabine 4 -12 mg/day for 14 weeks.…”

“…Several studies have reported that tiagabine does not seem to adversely affect patients' sexual functioning [25,26,38]. The onset or worsening of sexual dysfunction is increasingly recognised as an adverse event associated with antidepressant therapy, particularly those with predominantly serotonergic effects, such as the SSRIs and SNRIs [39].…”

Is Tiagabine Helpful in Generalized Anxiety Disorder?

“…The article by Schwartz et al (1) demonstrates the possible pitfalls of short-term treatment studies. The mean HAMA scores decreased from baseline to week 8 and then increased between weeks 8 and 14.…”