Fluoxetine and fluvoxamine in PTSD.
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Biomedical subjects
Publications and source records attributed to J S March.
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The authors employed a double-blind, placebo-controlled design to investigate the effectiveness of fluvoxamine versus imipramine in 54 outpatients with moderate major depression. Fluvoxamine proved superior to placebo but not to imipramine on the Hamilton Rating Scale for Depression and the Montgomery and Asberg Depression Rating Scale. Nausea and hyperarousal were the most common side effects in the fluvoxamine-treated patients.
Thirty-two nondepressed patients with obsessive compulsive disorder were randomly assigned to treatment with clomipramine (N = 16) or placebo (N = 16) in a 10-week double-blind study. Of the 15 patients who received at least 3 weeks of clomipramine treatment, 11 (73%) improved, 5 (33%) improved by more than 50%, and none worsened. Only 2 (12.5%) of the 16 placebo-treated patients improved, 1 (6%) by more than 50%; two (13%) worsened. Clomipramine treatment was associated with statistically significant improvement on several measures of obsessive compulsive symptoms. Side effects were more frequent and severe with clomipramine than with placebo. Although most patients tolerated clomipramine well, 3 discontinued treatment because of side effects.
Patients with obsessive-compulsive disorder complain of anxiety-producing intrusive thoughts and/or perform repetitive, anxiety-reducing rituals. A combination of behavior therapy and drug therapy is generally beneficial in this relatively common disorder. Behavior therapy consists of exposing patients to anxiety-provoking situations and helping them avoid ritualistic responses. Drug therapy appears to work by blocking serotonin reuptake in the brain.
Recognized since the Middle Ages, and clearly described for more than 100 years, obsessive-compulsive disorder (OCD) continues to intrigue and challenge mental health professionals. Recent evidence has implicated dysfunctional serotonergic neurotransmission in OCD. This review summarizes the evidence favoring a serotonergic hypothesis for OCD followed by a more detailed discussion of the implications the hypothesis holds for treatment.