Depression, Anxiety, Obsessive-Compulsive Disorder

Kevin Leehey, M.D.
1200 North El Dorado Place
Building H, Suite 800
Tucson, AZ 85715
(520) 296-4280

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

tablet, scored
10 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 pleasasnt or feel like anxiety, agitation or irritabliity. Zoloft and Paxil may sedate (rarely Prozac), Luvox most likely to sedate.

Decreased appetite, sometimes with nausea. Less
if taken with food.
25-30% experience
decreased sex drive or
response.

Less common: increased urinary frequency, dry mouth or sweating, vivid dreams.
Some migraine increase with Prozac.
Once a day for Prozac, Zoloft and Paxil. Very good safety profile.

No labs, no EKG typically needed. No heart side-effects. Few significant interactions except increases Seldane, Hismanal and tricyclic antidepressant blood levels.

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

Research does not show significant increased suicide or homicide risk. Very low risk in overdose. Reportedly, low risk in pregnancy and breast feeding.

SRI side effects (as with most meds) often lessen with time. Any SRI, especially Prozac, may agitate 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.

Celexa became available in US Sept.98, although it has been in use in Europe substantially since about 1990.

Zoloft
(Sertraline) tablet, scored
25 mg
50 mg
100 mg
liquid
20mg/cc usually a.m., evening if sedation
Child: 25-50 mg
Adoles: 50-100 mg
Adult: 50-200 mg

Paxil
(Paroxetine) tablet, scored
10 mg
20 mg
30 mg
40 mg
liquid
10mg/5cc
usually a.m.,evening if sedation
Child: 5-30 mg
Adoles: 10-60 mg
Adult: 10-80 mg

Luvox
(Fluvoxamine)
tablet, scored
25 mg
50 mg
100 mg often twice a day evening if sedation
Child: 25-200 mg
Adoles: 50-300 mg
Adult: 100-300 mg

Celexa
(Citalopram) tablet, scored
20mg
40mg usually a.m., evening if sedation Child: 5-20mg
Adoles: 10-40mg
Adult: 10-80mg similar to other SRI, but may be less frequent

Effexor
(Venlafaxine) tablet, scored
25 mg
37.5 mg
75 mg
100 mg

xr(extended release)
37.5 mg
75 mg
150 mg 2 or 3 times a day

XR once a day Child: 18 3/4-200 mg
Adoles: 75-300 mg
Adult: 150-375 mg Same as other SRI Effexor increases both serotonin and norepinephrine thus affecting two important neurotransmitter systems, unlike other SRI's. May help attention deficit hyperactivity disorder (ADHD) Slight risk increased blood pressure at doses over 200 mg total a day. (less than 5% chance.)

Same as above

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.

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 tablet, scored 10 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 pleasasnt or feel like anxiety, agitation or irritabliity. Zoloft and Paxil may sedate (rarely Prozac), Luvox most likely to sedate. Decreased appetite, sometimes with nausea. Less if taken with food. 25-30% experience decreased sex drive or response. Less common: increased urinary frequency, dry mouth or sweating, vivid dreams. Some migraine increase with Prozac.	Once a day for Prozac, Zoloft and Paxil. Very good safety profile. No labs, no EKG typically needed. No heart side-effects. Few significant interactions except increases Seldane, Hismanal and tricyclic antidepressant blood levels. Excellent for mild, moderate and severe depressions and anxiety disorders including panic, mixed, obsessive compulsive, post traumatic stress and atypical types. Research does not show significant increased suicide or homicide risk. Very low risk in overdose. Reportedly, low risk in pregnancy and breast feeding. SRI side effects (as with most meds) often lessen with time.	Any SRI, especially Prozac, may agitate 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. Celexa became available in US Sept.98, although it has been in use in Europe substantially since about 1990.
	Zoloft (Sertraline)	tablet, scored 25 mg 50 mg 100 mg liquid 20mg/cc	usually a.m., evening if sedation	Child: 25-50 mg Adoles: 50-100 mg Adult: 50-200 mg
	Paxil (Paroxetine)	tablet, scored 10 mg 20 mg 30 mg 40 mg liquid 10mg/5cc	usually a.m.,evening if sedation	Child: 5-30 mg Adoles: 10-60 mg Adult: 10-80 mg
	Luvox (Fluvoxamine)	tablet, scored 25 mg 50 mg 100 mg	often twice a day evening if sedation	Child: 25-200 mg Adoles: 50-300 mg Adult: 100-300 mg
	Celexa (Citalopram)	tablet, scored 20mg 40mg	usually a.m., evening if sedation	Child: 5-20mg Adoles: 10-40mg Adult: 10-80mg	similar to other SRI, but may be less frequent
	Effexor (Venlafaxine)	tablet, scored 25 mg 37.5 mg 75 mg 100 mg xr(extended release) 37.5 mg 75 mg 150 mg	2 or 3 times a day XR once a day	Child: 18 3/4-200 mg Adoles: 75-300 mg Adult: 150-375 mg	Same as other SRI	Effexor increases both serotonin and norepinephrine thus affecting two important neurotransmitter systems, unlike other SRI's. May help attention deficit hyperactivity disorder (ADHD)	Slight risk increased blood pressure at doses over 200 mg total a day. (less than 5% chance.) Same as above