Obsessive-compulsive disorder sertraline

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. 

Zoloft (Sertraline) Depression Obsessive-compulsive disorders Panic Post traumatic stress disorder 2.0 0.7 1996 - EU and US Once daily... 

Sertraline (Zoloft, Pfizer) selective serotonin (5-hydroxytryptamine 5HT) uptake inhibitor for treating major depression and obsessive compulsive disorder... 

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. 

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. 

Murdoch D. and D. McTavish (1992). Sertraline A review of its pharmacodynamic properties and therapeutic potential in depression and obsessive compulsive disorder. Drugs 44 604-624. 

Alderman, J., Wolkow, R., Chung, M., and Johnston, H.E (1998) Sertraline treatment of children and adolescents with obsessive-compulsive disorder or depression pharmacokinetics, tolerability, and efficacy. / Am Acad Child Adolesc Psychiatry 37 386-394. 

B., Riesenberg, R., Rosenthal, M., Sallee, F.R., Wagner, K.D., and Steiner, H. (1998) Sertraline in children and adolescents with obsessive-compulsive disorder a multicenter randomized controlled trial. JAMA 280 1752-1756. 

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). 

Wiener, K, and Lamberti, J.S. (1993) Sertraline and mental retardation with obsessive-compulsive disorder. Am Psychiatry 150 1270. 

Sertraline is manufactured by Pfizer under the name Zoloft, in three dosages 25,50, and 100 mg. Zoloft is prescribed for depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. Sertraline is also used to treat obsessive-compulsive disorder in children. 

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]. 

Zimelidine was the first serotonin reuptake inhibitor available for clinical use, but in 1982 was withdrawn worldwide because of its toxicity ( 110). Despite this initial setback, five members of this class have been marketed in the United States and various countries around the world citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). All except fluvoxamine have marketed indications in the United States for the treatment of major depression. Fluvoxamine is marketed in the United States for the treatment of obsessive-compulsive disorder rather than major depression, although it is marketed in a number of other countries for major depression. 

Bick PA, Hackett E, Chouinard G. Multicenter placebo controlled study of sertraline in obsessive-compulsive disorder. Arch Gen Psychiatry 1989 46 23-28. 

Chouinard G, Goodman W, Greist J, et al. Results of a double-blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive-compulsive disorder. Psychopharmacol Bull 1990 26 279-284. 

Greist J, Chouinard G, DuBoff E, et al. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry 1995 52 289-295. 

Wolkow R, March J, Safferman A, et al. A placebo controlled trial of sertraline treatment for pediatric obsessive compulsive disorder. 6th World Congress of Biological Psychiatry 1997 42 213S-213S. 

A 12-year-old boy, who had taken sertraline 37.5 mg/day for 5 weeks for obsessive-compulsive disorder, started to take erythromycin 200 mg bd. Within 4 days he began to feel anxious this was followed over the next 10 days by panic, restlessness, irritability, tremulousness, and confusion. These symptoms resolved within 72 hours of withdrawal of sertraline and erythromycin. 

A 15-year-old youth with Asperger s syndrome, Tourette s syndrome, and obsessive-compulsive disorder was stabilized on risperidone 1.5 mg bd and sertraline 100 mg od and had marked improvement in his social skills and tics, until he was given tetracycline 250 mg bd for acne. Within 2 weeks his tics were acutely exacerbated with pronounced neck jerking and guttural sounds. The sertraline was increased to 150 mg/day, but the tics did not resolve. The tetracycline was withdrawn after 1 month, and the tics improved within a few weeks. 

Sertraline hydrochloride is used in the management of depression, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder. 

Obsessive compulsive disorder, panic disorder, generalized anxiety disorder, bulimia nervosa, social anxiety disorders, post-traumatic stress disorder, dementia, dysthymia, premature ejaculation. Citalo-pram (investigational) is used for dementia, smoking cessation, ethanol abuse, OCD in children with diabetic neuropathy. Sertraline and Sarafem (contains fluoxetine) are also used to treat premenstrual dysphoric disorder. 

Although several antidepressants are EDA-approved for use in children, only one, fluoxetine, is currently approved for childhood depression. Imipramine is approved for the treatment of enuresis, clomipramine for obsessive-compulsive disorder in children 12 years and older, and fluvoxamine along with fluoxetine is approved for obsessive-compulsive disorder in children. The treatment of depression in children remains challenging, as depression can be difficult to diagnose and treat once identified. The studies involving imipramine, sertraline, and fluoxetine found that the dose range and titration as well as adverse effects were similar to those in adults. " ... 

Selective serotonin reuptake inhibitors (SSRIs) A relatively new group of medicines that have been used successfully to treat emotional and behavioral problems such as depression, panic disorder, obsessive-compulsive disorder ((XID), bulimia, and posttraumatic stress disorder in adults. These medications are now being used to treat the same types of behavior in children. Some examples of SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Paxil (paroxetine). 

Sertraline (brand name Zoloft) An antidepressant medication that functions as an SSRI prescribed primarily for major depression. It can also be used to treat obsessive-compulsive disorder. Some side effects include difficulty with ejaculation, dry mouth, dizziness, and decreased sex drive. 

Sertraline (50 mg p.o. daily) is a nontricycUc, potent, and selective serotonin reuptake inhibitor (SSRI) which is currently approved in the treatment of depression. The role of serotonin in the etiology of obsessive compulsive disorder (OCD) has been estabhshed through considerable indirect evidence. The strongest evidence comes from the fact that drugs known to be SSRIs have been found to be useful in the pharmacotherapy of OCD (see also Figure 86 and Tables 5 through 7). 

Clomipramine, a tricyclic, is a more selective inhibitor of serotonin reuptake than other drugs in its class. This activity appears to be important in the treatment of obsessive-compulsive disorder (OCD). Patients with OCD are also responsive to sertraline and other selective serotonin reuptake inhibitors, and the SSRIs have now become the drugs of choice for this disorder since they are safer in overdose than tricyclics. The answer is (C). 

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

---