Fluoxetine

Fluoxetine REF: Kaplan 9^th ed p — 622

OCD

Treatment of choice: behaviour therapy Drug of choice: SSRI

2nd drug of choice: comipramine

Fluoxetine [Ref: Harrison 17⁶/e p. 2715]

The drug of choice for obsessive compulsive disorder is Fluoxetine.

Remember

• The treatment of choice for obsessive compulsive disorder is behavior therapy. (Only 50% of OCP patients show improvement with pharmacotherapy alone).

Fluoxetine

Ans:B-Fluoxetine

Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include:

• Clomipramine (Anafranil) for adults and children 10 years and older
• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine for adults and children 8 years and older
• Paroxetine (Paxil, Pexeva) for adults only
• Sertraline (Zoloft) for adults and children 6 years and older

Fluoxetine

Serotonin 

Ans.B. Fluoxetin

This patient is suffering from obsessive-compulsive disorder (OCD). Preferentially Selective Serotonin Reuptake Inhibitors (SSRIs), the medications most effective in treating OCD, mainly inhibit their reuptake of serotonin into nerve cells.

These medications include clomipramine, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine.

Medications with noradrenergic reuptake inhibition produce no benefit and may counteract or diminish the efficacy of serotonergic reuptake inhibition.

The lady in the question experiences frequent panic attacks and hence the diagnosis is panic disorder.

Alprazolam and Lorazepam may be used for short term treatment of panic attacks.

However SSRIs are the long term treatment options along with psychotherapy.

Olanzapine is an anti-psychotic. Diazepam is useful to reduce anxiety but it is not as fact acting as Lorazepam.

Betablockers are good to reduce the physical symptoms like palpitations and sweating.

However it cannot reduce the psychological symptoms of panic attack like the fear of death and severe anxiety.

Strong serotonin increasing drugs are used to treat Obsessive Compulsive Disorder. SSRIs (Selective Serotonin Reuptake Inhibitors), particularly Fluoxetine is the drug of choice for the condition. Clomipramine is also widely used to treat OCD.

CBT or Cognitive Behavioural Therapy is instituted along with the use of mediicnes.

SRIs are considered to be the drug of choice in OCD.

SSRIs used in OCD are fluoxetine, fluvoxamine, paroxetine, sertraline and citalopram.

SSRIs are considered to be superior than TCAs because side effects of SSRIs are transient and less troubling. 

• The selective serotonin reuptake inhibitors (SSRIs) are now considered to be first-line drug treatments in the management of obsessive compulsive disorder.
• Fluoxetine is the drug of choice.
• The doses are usually higher than for anti-depressant action.
• Clomipramine is still considered as a good option when fluoxetine does not work.
• Clomipramine has the most specific seratoninergic effects among the Tricyclic Antidepressants (TCAs). 

Gastrointestinal disturbance are the most common side effects of fluoxetine therapy.

Other common side effects associated with fluoxetine are nausea, anxiety, insomnia, loss of appetite, sexual dysfunction, mild jaw and neck muscle stiffness, and head aches.

Ref: Personality Disorders: New Symptom-Focused Drug Therapy By Sonny Joseph, 1997, Page 190.

A i.e. Fluoxetine

Ans:B-Fluoxetine

• The new antidepressants are moclobemide, fluoxetine, paroxetine and sertraline.
• They are as effective as the established antidepressants, have fewer adverse effects and are safer in overdose.
• The new drugs are more likely to be taken in an effective dosage for an adequate period of time.

C i.e. Inhibition of axonal uptake of 5 HT

A i.e. Fluoxitine

B i.e. Anxiety 

C i.e. Urinary retention

SSRIs (ex. Fluoxetine) are almost devoid of sedation, hypotension, cardiac arrhythmia, seizure precipitation & anticholinergic side effectsQ, such as dry mouth, bad taste, urinary retention, constipation & epigastric distressQ when compared to tricyclic antidepressants.

–    Least sedative antidepressants are – Venlafaxine (atypical), Tianeptine & Citalopram (SSRI) > other SSRIs fluoxetine, fluvoxemine, paroxetine, sertraline)Q.

At that time (1993), Selective serotonin reuptake inhibitors fluoxetine, fluvoxamine, paroxetine, Sertraline & Citolapram were the latest antidepressant. Now Venlafaxine, Nifazodone, Reboxetine, Mirtazapine, Tianeptine are novel antidepressants.

–  Fluoxetine is a longest acting SSRI (Selective serotonin reuptake inhibitor). It is devoid of anticholinergic, arrythmogenic, sedative (abuse liability) & Hypotensive side effectsQ. It has new constellation of mild S/E viz – Nervousness, Anxiety, Insomnia, Anorexia, Nausea, DiarrheaQ & Headache, Weight lossQ. Fluoxetine, by inhibiting drug metabolism can elevate drug levels of TCA & Haloperidol to dangerous level.

–  Gastrointestinal S/E of SSRI’s are anorexia, nausea, vomiting, diarrheoa. Anorexia is most common in fluoxetine & weight loss begin as soon as drug is taken & peak at 20 weeks, after which weight often returns to baseline. Although most patient loose weight but some person gain weight while taken fluoxetine. (Kaplan & Sadock’s – Synopsis of Psychiatry 9/e P. 1099)

–  Buprenorphine & Dextroprophoxyphene are opioids & have abuse liability.

–  Increased psychomotor activity like anxiety, akathesia, agitation and insomnia is seen in one quarter of persons initiating treatment with SSRIs specifically fluoxetine.

Tianeptine is an antidepressant which increase rather than inhibit 5-HT (Serotonin) uptakeQ.

Treatment of choice for OCD – Behaviour therapyQ. Drug of choice for OCD is fluoxetineQ > ClomipramineQ

A i.e. Fluoxetine

• Selective serotonin reuptake inhibitors (SSRIs) are devoid of : anticholinergic side effects (i.e. no urinary retention & can be used in benign prostate hypertrophy), a adrenergic blocking action (i.e. no hypotension), cardiac arrhthymias, sedation and seizure precipitation.
• Due to lack of hypotension, arrhthymia & anticholinergic side effects SSRIs (eg fluoxetine) are relative drug of choice in elderly depressed patientsQ. SSRIs are 1^st line drugs in OCD, depression & phobia.

* SSRIs & MAOI should never be used concurrently (atleast 2 weeks should elapse b/w the use) because serotonin syndrome might develop.

B i.e. Fluoxetine

Although SSRIs may cause diarrhea, anxiety, headache etc, these adverse effects are often transient & often less troubling than adverse effects associated with tricyclic drugs, such as clomipramine which causes significant sedation & anticholinergic effects including dry mouth & constipation.

Ans. is ‘a’ i.e., Fluoxetine

Ans. is ‘d’ i.e., Loose stools

o Amongst the given options, option d i.e. is the best answer (read below).

o Most common side effects on long term treatment is sexual dysfunction. However, you should keep in mind sexual dysfunction is the most common side effect on long term use. Otherwise, mused and GI disturbances are the most common side effects.

“Transient nausea is the most frequent complainst with the SSRIs”.    — Katzung

“The prominant side effects with SSRIs are gastrointestinal”.   —KDT

“Gastrointestinal side effects are very common. The most frequent GI complaints are nausea, diarrhea, anorexia, flatulence, dyspepsia”.  — Kaplan & Saddocks

• So, remember following facts :-

(i)     The most common side effect of SSRIs is transient nausea.

(ii)   If nausea is not given in options, then any other GI symptom (diarrhea, vomiting, anorexia) is the best answer.

(iii)  The most common side effect of SSRIs on long term use is sexual dysfunction.

Ans. is ‘a’ i.e., Fluoxetine

Ans. is ‘a’ i.e., Fluoxetine

SSRIs are drug of choice for ‑

• OCD             
• Panic disorder     
• Premenstural dysphoric disorder
• Eating disorders
• Depression 
• Social phobia
• Post traumatic stress disorder

Ans. D: Fluoxetine

Serotonin is a chemical in the brain called a neurotransmitter that may be imbalanced in people with OCD.

While both drugs are very effective, SSRIs have generally become the preferred medication for anxiety disorders including OCD.

SSRIs have less side effects than other forms of antidepressants, less withdrawal symptoms, less danger in the event of an overdose and overall are considered safer that other types of drugs (TCAs and SSRIs are both very safe drugs, however). Common SSRIs include fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram.

Ans. is ‘a’ i.e., Fluoxetine

Selective serotonin reuptake inhibitors (SSRI)

• 5-HT (serotonine) is the major player in depressive illness and serotonergic pathways are closely related to mood disorders especially depression.
• Thus, drugs affecting the 5-HT levels in the neural synapse and serotonergic pathways are effective in the treatment of depression.
• Therefore, the SSRIs have been shown to alleviate depression and are the most commonly used drugs in the therapy of depression.
• These drugs act by inhibiting reuptake of 5-HT.
• These drugs are now 1st choice for depression.
• Advantages over TCAs.

1.Little or no sedation, no weight gain.

2.No interference with psychomotor or cognitive function.

3.No anticholinergic side effects.

4.No postural hypotension (no action of a-adrenergic receptors).

5.No propensity to cause seizures or arrythmias.

Ans. is ‘d’ i.e., Fluoxetine

Drugs used for alcohol dependence to prevent relapse are:

• Naltrexane
• Acamprosate
• Ondansetron
• Nalmefene
• Disulfiram
• Topiramate

Ans. is ‘a’ i.e., Fluoxetine