Skip to main content
. Author manuscript; available in PMC: 2024 Sep 1.
Published in final edited form as: Neurosci Biobehav Rev. 2023 Jul 25;152:105327. doi: 10.1016/j.neubiorev.2023.105327

Table 2.

Pharmacological treatments interact with neurosteroid synthesis.

MEDICATION CLASS INDICATION IMPACT ON 5a-REDUCED NEUROSTEROIDS REFERENCE
ANTIDEPRESSANTS
AMITRIPTYLINE Tricyclic MDD Off-label: anxiety, insomnia, treatment-resistant depression + (Jaworska-Feil et al., 2000)
DOXEPIN Tricyclic MDD, insomnia Off-label: anxiety ?
IMIPRAMINE Tricyclic MDD Off-label: insomnia no effect (Haduch et al., 2011; Uzunov et al., 1996; Guidotti & Costa, 1998)
TRAZODONE Atypical MDD Off-label: insomnia, anxiety + (Korade et al., 2017)
MIRTAZAPINE Atypical MDD Off-label: panic disorder, GAD, PTSD + (Schüle et al., 2006)
FLUOXETINE SSRI MDD, OCD, panic disorder, treatment-resistant depression, acute depression in Bipolar I disorder, PMDD. Off-label: social anxiety disorder and PTSD + (Griffin & Mellon, 1999; Guidotti & Costa, 1998; Pinna et al., 2003; Uzunova et al., 1998; Guidotti & Costa, 1998)
PAROXETINE SSRI MDD, OCD, GAD, PTSD, social anxiety disorder, PMDD + (Griffin & Mellon, 1999; Alessandr o Guidotti & Costa, 1998)
SERTRALINE SSRI MDD, panic disorder, OCD, PTSD, social anxiety disorder, PMDD Off-label: GAD + (Griffin & Mellon, 1999)
CITALOPRAM SSRI MDD Off-label: PMDD, OCD, panic disorder, GAD, PTSD, social anxiety disorder ?
ESCITALOPRAM SSRI MDD, GAD Off-label: panic disorder, OCD, PTSD, social anxiety disorder, PMDD + (Haduch et al., 2011)
VENLAFAXINE SNRI MDD, GAD, social anxiety disorder Off-label: PMDD + (Haduch et al., 2011)
DESVENLAFAXINE SNRI MDD ?
DULOXETINE SNRI MDD, GAD ?
BUPROPION Atypical MDD, Seasonal affective disorder ?
PHENELZINE “Irreversible” MAOI MDD, treatment-resistant depression ?
ISOCARBOXAZID “Irreversible” MAOI MDD ?
TRANYLCYPROMINE “Reversible” MAOI MDD Off-label: treatment-resistant depression, social anxiety disorder, panic disorder, atypical depression ?
SELEGILINE “Reversible” MAOI MDD ?
BREXANOLONE Neurosteroi d Analog PPD + (Balan et al., 2023)
KETAMINE Dissociative Anesthetic Treatment-resistant depression + (Korneyev et al., 1993; Li et al., 2016)
ANXIOLYTICS
ALPRAZOLAM Benzodiaza pine GAD, panic disorder, anxiety associated with depression. Off-label: PMS, PMDD, insomnia, adjunct with acute mania, acute psychosis ?
CHLORDIAZEP OXIDE Benzodiaza pine GAD ?
CLONAZEPAM Benzodiaza pine Panic disorder Off-label: adjunct treatment of acute mania, acute psychosis, or insomnia no effect (Korneyev et al., 1993; Tokuda et al., 2010)
DIAZEPAM Benzodiaza pine anxiety disorder Off-label: insomnia + (Wolf et al., 2015)
LORAZEPAM Benzodiaza pine anxiety disorder Off-label: insomnia, panic disorder, adjunct with acute mania or acute psychosis ?
HYDROXYZINE Antihistamine Anxiety ?
MADAZOLAM Benzodiaza pine Anxiety + (Dhir & Rogawski, 2012; Tokuda et al., 2010)
ETIFOXINE Benzooxazine Anxiety + (Luc Do Rego et al., 2015; Wolf et al., 2015)
BUSPIRONE Azapirone GAD ?
ANTIPSYCHOTICS
OLANZAPINE Thio-Benzodiaze pine Schizophrenia, Bipolar I Disorder, treatment-esistant depression + (Marx et al., 2003; Marx, Shampine, et al., 2006)
QUETIAPINE Dibenzo-Thiazepine Derivative Schizophrenia, depressive episodes in Bipolar I disorder, adjunctive treatment in MDD no effect (Marx, Shampine, et al., 2006)
RISPERIDONE Benzisoxazole Derivative Schizophrenia, acute mania/mixed episodes due to Bipolar I dDsorder, irritability associated with autism spectrum disorder no effect (Marx et al., 2003)
ZIPRASIDONE Benzo-Thiazolyl-Piperazine Derivative Schizophrenia, acute mania/mixed episodes due to Bipolar I Disorder no effect (Marx, Shampine, et al., 2006)
ARIPIPRAZOLE Benzisoxazole Derivative Schizophrenia, Bipolar I Disorder no effect (Marx, Shampine, et al., 2006)
CLOZAPINE Dibenzo-Diazepine Schizophrenia, suicidality in Schizophrenia + (Barbacci a et al., 2001; Marx et al., 2003; Marx, Shampine, et al., 2006)
THIOTHIXENE Thioxanthene Derivative Schizophrenia ?
THIORIDAZINE Piperidine Phenothiazine Schizophrenia. Off-label: depression with psychotic features + (Haduch et al., 2011)
CHLORPROMA ZINE Dimethylamine Phenothiazine Derivative Schizophrenia, psychoses, hyperexcitability, combative behavior in children Off-label: Bipolar I Disorder ?
HALOPERIDOL Butyrophen one Schizophrenia, manic states, drug-induced psychoses, hyperexcitability, agitation no effect (Barbaccia et al., 2001; Marx et al., 2003)
PALIPERIDONE Benzisoxazole Derivative schizophrenia, schizoaffective disorder ?
ASENAPINE Dibenzo-Oxepino Pyrrroles schizophrenia, manic/mixed episodes associated with bipolar I disorder + (Danek et al., 2021)
LURASIDONE Benzisoxaz ole Derivative schizophrenia, depressive episodes in Bipolar I disorder + (Danek & Daniel, 2022)
ILOPERIDONE Benzisoxaz ole Derivative schizophrenia + (Danek & Daniel, 2021)
CARIPRAZINE Atypical schizophrenia, acute mania/mixed episodes due to bipolar I disorder ?
BREXPIPRAZO LE Serotonin-Dopamine Activity Modulators (SDAM) schizophrenia, adjunct treatment of MDD ?
MOOD STABILIZERS
LITHIUM Antimanic Bipolar I Disorder + (Marx et al., 2008; Maayan et al., 2004)
CARBAMAZEPI NE Anticonvuls ant Bipolar I Disorder + (Eagle et al., 2020; Jaworska-Feil et al., 2000; Yoshizaw a et al., 2020)
DIVALPROEX Anticonvuls ant Bipolar Disorder ?
LAMOTRIGINE Anticonvuls ant Bipolar Disorder ?
+

indicates evidence of an interaction with the specified drug and neurosteroid synthesis,

?

indicates no known evidence of an interaction. Abbreviations: Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Post Traumatic Stress Disorder (PTSD), Obsessive Convulsive Disorder (OCD), Premenstrual Dysphoric Disorder (PMDD), Postpartum Depression (PPD), Premenstrual Syndrome (PMS).