Obsessive-compulsive disorder fluoxetine

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Prozac (Fluoxetine) Depression Obsessive-compulsive disorders Panic Post-traumatic stress disorder 2.9 1.0 1988 - US 1989 - UK Once daily... 

Zohar and Insel have suggested that the s)nnptoms of obsessive-compulsive disorder are due to supersensitive 5-HTi-type receptors and that the function of SSRIs such as clomipramine, fluoxetine and the non-selective 5-HT antagonist metergoline owe their efficacy to their ability to reduce the activity of these receptors. 

Sertraline is a recent antidepressant that is called a selective serotonin reuptake inhibitor (SSRI). It is chemically unrelated to the older tricyclic antidepressants (see Section 5.3). It works by preventing the movement of the neurohormone serotonin into nerve endings. It can help to improve mood and mental alertness, increase physical activity, and improve sleep patterns. It is prescribed for obsessive-compulsive disorder and obesity. It may offer some advantage over fluoxetine by exhibiting little central nervous system (CNS) action. It has less sedation and anxiety and is shorter acting. 

Like sertraline, these two drugs are selective serotonin reuptake inhibitors. Fluoxetine is prescribed for depression, bulimic binge-eating and vomiting, obsessive-compulsive disorder, obesity, alcoholism, and anorexia among other ailments. Paroxetine is used for depression and obsessive-compulsive disorder. Interestingly the three top antidepressants are chemically unrelated to each other, except for being amines, and are unrelated to earlier tricyclic antidepressants. 

Citalopram, escitalopram, and paroxetine are not approved for use in pediatric patients. Fluoxetine is approved for use in pediatric patients with MDD and obsessive-compulsive disorder (OCD). Sertraline is not approved for use in pediatric patients except for patients with OCD. Fluvoxamine is not approved for use in pediatric patients except for patients with OCD. 

Obsessive-compulsive disorder (OCD) Fluoxetine fluvoxamine paroxetine (immediate-release), sertraline. 

Due to the frequent unwanted effects and, in case of tranylcypromine, the numerous and dangerous interactions MAO-inhibitors are more and more replaced by the much less problematic SSRIs. Compounds belonging to this group are citalopram, escitalopram, fluoxetine, paroxetine and sertraline. They are used clinically in the therapy of depression, bulimia and obsessive-compulsive disorders. All SSRIs show a slow onset of action (1-2 weeks). They may induce insomnia and weight loss. The antidepressant ven-lafaxine inhibits both, serotonin and noradrenaline re-uptake and might therefore additionally induce hypertension. 

Lesch KP, Hob A, Schulte HM (1991) Long-term fluoxetine treatment decreases 5-HTlA receptor responsivity in obsessive compulsive disorder. Psychopharmacology (Berl) 105 415-420... 

In 1987, the FDA approved the drug fluoxetine (Prozac) for use in the treatment of major depression. Fluoxetine belongs to a class of agents referred to as selective serotonin reuptake inhibitors (SSRIs). The SSRIs now include sertraline (Zoloft), fiuvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa). Fiuvoxamine is approved for use only in obsessive-compulsive disorder and is not discussed in this chapter. 

Greenberg, B.D., Benjamin, J., Martin, J.D., Keuler, D., Huang, S.J., Altemus, M., and Murphy, D.L. (1998) Delayed obsessive-compulsive disorder symptom exacerbation after a single dose of a serotonin antagonist in fluoxetine-treated but not untreated patients. Psychopharmacology 140 434-444. 

Geller, D.A., Hoog, S.L., Heiligenstein, J.H. (2001) Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents a placebo-controlled clinical trial. / Am Acad Child Adolesc Psychiatry 40 773—779. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

Como, P.G. and Kurlan, R. (1991) An open-label trial of fluoxetine for obsessive-compulsive disorder in Gilles de la Tourette s Syndrome. Neurology 41 872-874. 

Geller, D., Biederman, J., Reed, E., Spencer, T, and Wilens, T. (1995) Similarities in response to fluoxetine in the treatment of children and adolescents with obsessive-compulsive disorder. / Am Acad Child Adolesc Psychiatry 34 36—44. 

Liebowitz, M., Hollander, E., Fairbanks, J., and Campeas, R. (1990) Fluoxetine for adolescents with obsessive-compulsive disorder. Am J Psychiatry 147 370—371. 

Simeon, J. and Thatte, S. (1990) Treatment of adolescent obsessive-compulsive disorder with clomipramine-fluoxetine combination. Psychopharmacol Bull 26 285—290. 

Riddle, M.A., Hardin, M.T., King, R., Scahill, L., and Woolston, J.L. (1990) Fluoxetine treatment of children and adolescents with Tourette s and obsessive compulsive disorders preliminary clinical experience. / Am Acad Child Adolesc Psychiatry 29 45 8. 

Fluoxetine is manufactured by Eli Lilly under the name Prozac, as a 10-mg green football-shaped tablet or a 20-mg green and white capsule. It was the first SSRI introduced for the treatment of depression and anxiety disorders. Fluoxetine is prescribed for obsessive-compulsive disorder, the eating disorder bulimia nervosa, and panic disorder. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

The selective serotonin reuptake inhibitors (SSRls) have received increased attention in the treatment of anxiety disorders. With the recent Food and Drug Administration (FDA) approval of fluoxetine and fluvoxamine in the treatment of obsessive-compulsive disorder, it has been made clear that this... 

Paroxetine. Paroxetine, also a serotonin reuptake inhibitor, has been the subject of a case report in two subjects. Ringold [1994] reported the effective treatment of two individuals who had not responded to prior therapy with fluoxetine and sertraline. Both individuals had comorbid psychiatric problems. Subject A demonstrated both social phobia and dysthymia. Although her symptoms of dysthymia were clinically responsive to fluoxetine therapy, her social phobia symptoms were resistant. Subject B had body dysmorphic disorder, obsessive-compulsive disorder, and social phobia. His obsessive-compulsive disorder symptoms benefited from fluoxetine therapy, but his social anxiety was resistant. Sertraline therapy was attempted in both subjects. Subject A required discontinuation because of adverse effects. Subject B experienced a worsening of both obsessive-compulsive disorder and social phobia symptoms. Both subjects demonstrated a positive response in their symptoms when switched to paroxetine [20 mg/day]. 

Cox BJ, Swinson RP, Morrison B, Lee PS Clomipramine, fluoxetine and behavior therapy in the treatment of obsessive-compulsive disorder a meta-analysis. J Behav Ther Exp Psychiatry 24 2, 149-153, 1993a... 

Grady TA, Pigott TA, L Heureux PL, et al Double-blind study of adjuvant buspirone for fluoxetine-treated patients with obsessive-compulsive disorder. Am J Psychiatry 150 819-821, 1993... 

Hollander E, Schiffman E, Cohen B, et al Signs of central nervous system dysfunction in obsessive-compulsive disorder. Arch Gen Psychiatry 47 27-32, 1990b Hollander E, Mullen L, DeCaria CM, et al Obsessive compulsive disorder, depression, and fluoxetine. J Clin Psychiatry 52 418-422, 1991 Hollander E, De Caiia CM, Nitescu A, et al Serotonergic function in OCD. Arch Gen Psychiatry 49 21-28, 1992... 

Jenike MA, Baer L, Buttolph L Buspirone augmentation of fluoxetine in patients with obsessive compulsive disorder. J Clin Psychiatry 52 13-14, 1991a Jenike MA, Baer L, Ballantine HT, et al Cingulotomy for refractory obsessive-compulsive disorder a long-term follow-up of 33 patients. Arch Gen Psychiatry 48 548-555, 1991b... 

Markovitz PJ, Stagno SJ, Calabrese JR Buspirone augmentation of fluoxetine in obsessive-compulsive disorder. Am J Psychiatry 147 798-800, 1990 Markowitz JS, Weissman PH, Ouelette R, et al Quality of life in panic disorder. Arch Gen Psychiatry 46 984-992, 1989... 

Tollefson GD, Rampey AH Jr, Potvin JH, et al A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 51 559-567, 1994... 

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