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Re: Paxil: Lunatic Drug????/been there, Judy

Posted by Elizabeth on July 5, 1999, at 13:03:35

In reply to Re: Paxil: Lunatic Drug????/been there, Judy, posted by Deb on July 5, 1999, at 10:29:39

Hi everyone.

I haven't heard about this thing about Prozac vs. Luvox vs. Paxil vs. whatever; as far as I know, all of them work in OCD, but one may be better than another for a particular person.

I do know that clomipramine (Anafranil) is supposed to work *better* than the newer SSRIs (it being a tricyclic antidepressant and a powerful inhibitor of both serotonin and noradrenaline reuptake). However, it does have some pretty nasty side effects for many people. I am not entirely convinced by the claims that it works "better," which are based on a somewhat controversial statistical technique; direct head-to-head comparisons of SSRIs vs. clomipramine have shown no significant difference in efficacy and better tolerability for the SSRIs. It is true that doses for OCD tend to be on the high end, and it can take a long time for improvement to become apparent. The recommendations I've seen have been that you shouldn't give up on an OCD drug until you've tried it at a fairly high dose (e.g., at least 60mg of Prozac or Paxil, 200 of Zoloft, 250 of clomipramine, 300 of Luvox) for 10-12 weeks.

FWIW, there are augmentation strategies that may prove helpful for some people. The ones I've heard of are Buspar, clonazepam (Klonopin or Rivotril), lithium, and Risperdal (be careful with this last, it's also been reported to worsen symptoms in some patients). Fenfluramine also has been used with success; for obvious reasons, I'm not recommending that!




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