Which medications in the drug class Selective Serotonin Reuptake Inhibitors are used in the treatment of Obsessive-Compulsive Disorder?

Updated: May 17, 2018
  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Selective Serotonin Reuptake Inhibitors

First-line pharmacologic treatments consist of selective serotonin reuptake inhibitors (SSRIs). SSRIs have the advantages of ease of dosing and low toxicity in overdose. Available SSRIs include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft). SSRIs are generally preferred over clomipramine in treating OCD. The adverse effect profiles of SSRIs are less prominent, so improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with TCAs, however, dose-dependent QT prolongation has been reported with citalopram. Because of the risk for QT prolongation, citalopram is contraindicated in individuals with congenital long QT syndrome and the dose should not exceed 40 mg/d. [36, 37] Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when treating a child or adolescent with a mood disorder.

Fluoxetine (Prozac)

Fluoxetine selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine. Selective serotonin inhibitors such as fluoxetine have less sedation, cardiovascular, and anticholinergic effects than the TCAs.

Citalopram (Celexa)

Citalopram enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane. Citalopram is FDA approved for depression but has been used for the treatment of anxiety disorders. SSRIs are the antidepressants of choice due to minimal anticholinergic effects.

Paroxetine (Paxil)

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.

Sertraline (Zoloft)

Sertraline selectively inhibits presynaptic serotonin reuptake at the neuronal membrane. It is FDA approved for the treatment of OCD, posttraumatic stress disorder, panic disorder, and social anxiety.

Fluvoxamine (Luvox)

Fluvoxamine enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than TCAs. It is FDA-approved for OCD in children (8-17 y) and adults.

Escitalopram (Lexapro)

Escitalopram is an SSRI and S-enantiomer of citalopram. Its mechanism of action is thought to be potentiation of serotonergic activity in the CNS, resulting from inhibition of CNS neuronal reuptake of serotonin.


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