Kevin Leehey, M.D.
1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835
MEDICATIONS FOR DEPRESSION, ANXIETY,
AND OBSESSIVE-COMPULSIVE DISORDER (Part I)


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Group Main Use Medication
Brand/Generic
Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group
SRI
Serotonin
Reuptake
Inhibitors

(depression, anxiety,OCD, panic)
Prozac
(fluoxetine)

capsule
10 mg, 20 mg, 40 mg, 90 mg/weekly

tablet, scored
10, 20 mg

liquid
20 mg/5cc

usually a.m. Child: 5-20 mg
Adoles: 10-40 mg
Adults: 20-80 mg

Increased energy which may be pleasant or feel like anxiety, agitation or irritabliity. Zoloft and Paxil may sedate (rarely Prozac), Luvox most likely to sedate. Celexa and Lexapro are the most neutral, regarding energy.



Decreased appetite, sometimes with nausea. Less if taken with food. With time, weight may increase.
25-40% experience decreased sex drive or
response.



Less common for group: increased urinary frequency, dry mouth or sweating, vivid dreams.
Once a day. Very good safety profile.


No labs, no EKG typically needed. No, or few, heart side-effects. Few significant interactions except increases tricyclic antidepressant blood levels. Zoloft and Celexa lowest interactions.


Excellent for mild, moderate and severe depressions and anxiety disorders including panic, mixed, obsessive compulsive, post traumatic stress and atypical types. May help temper and impulsivity.


Very low risk in overdose. Reportedly, low risk in pregnancy and breast feeding.

SRI side effects (as with most meds) often lessen with time.



All SRI's  are available as generic and are very inexpensive. Prozac available in once a week form. All SRI help PMS and perimenopausal symptoms.


Lexapro is a refined isomer version of Celexa.
Any SRI, especially Prozac, may agitate or disinhibit if excess energy occurs.


Switch to evening if sedation occurs. Takes 1-3 weeks to begin to help and 1-3 months for maximum effect.

Avoid combination or overlap with MAOI as with all antidepressants.


Discontinuation syndrome (nausea, dizziness, "flu-ish," "out of sorts") may occur if stopped suddenly without taper or skip one or several days. Not dangerous, but unpleasant. More likely with Paxil or Effexor, not with Prozac because it lasts longest. Can occur with any SRI, SNRI, or TCA.

FDA Caution: advise monitor for rare increased suicidal thoughts or behavior especially in kids when first starting medicine (age 24 and under)..


Celexa max dose now 40 mg to avoid possible heart rhythm effect.

Zoloft
(sertraline)
tablet, scored
25 mg, 50 mg, 100 mg

liquid
20mg/cc
(100mg=5cc)
usually a.m.; evening if sedation
Child: 25-50 mg
Adoles: 50-200 mg
Adult: 50-200 mg
Paxil
(paroxetine)





Paxil CR
tablet, scored
10 mg, 20 mg, 30 mg, 40 mg

 liquid
10mg/5cc

12.5, 25, 37.5 mg

usually a.m.,evening if sedation
Child: 5-30 mg
Adoles: 10-40 mg
Adult: 10-60 mg

Luvox
(fluvoxamine)



Luvox CR
tablet, scored
25, 50, 100 mg



Extended release capsules
100, 150 mg
often twice a day evening if sedation



once a day
Child: 25-200 mg
Adoles: 50-200 mg
Adult: 100-300 mg


100-300 mg
Celexa
(citalopram)



Lexapro
(escitalopram)

tablet, scored
10, 20, 40mg
liquid
10mg/5cc

tablet, scored
5, 10, 20 mg
liquid
5mg/5ml
usually evening if sedation



morning or evening
Child: 5-20mg
Adoles: 10-40mg
Adult: 10-40mg

Child: 5-10mg
Adoles: 10-20mg
Adult: 10-30mg
Viibryd
(depression)
vilazodone Tablets
10, 20, 40mg
Usually evenings or AM with food Adoles: 10-20mg
Adult: 10-40mg
diarrhea, nausea, similar to SRI, sedation Has SRI and 5HT-1A actions. Thus may have slightly broader action.
Brand only
Unclear, if any better than other SRI options. Newer and thus shorter track record
Trintellix
(depression)
Trintellix
vortioxetine
Tablets
5, 10, 15, 20mg
Usually once a day start 5-10 mg Adult: 10-20mg Nausea, GI, similar to SRI Has SRI, 5HT-1A and additional serotonin actions. Thus slightly broader actions.
Brand only. Was known as Brintellix.
Unclear, if any better than other SRI options. Newest and thus less experience.

All these medications should be taken 7 days a week to be effective. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All antidepressants may increase mania risk in persons with Bipolar (manic-depressive) disorder. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.

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