Why would you choose Zoloft over Lexapro as a first-line SSRI for MDD?

[birchswing]

I remember when Trintellix came out the big thing was about it hitting the sigma 1 receptor. I know very little about the drug. Just remember that being a thing.

I think Zofran is interesting for OCD. Seems like it's usually used with an SSRI. I don't have any experience with it. I just tend to think things are interesting when they're out of the box like that. Anafranil seems to be the gold standard.

I was on Luvox once briefly. Tell patients about the caffeine interaction. Wish I had known.

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[tr]

The pursuit of an OCD indication for fluvoxamine was motivated entirely by the manufacturer's feeling that the SSRI antidepressant space was too crowded. No one has ever demonstrated any advantage for luvox compared to any other SSRI. Only advantage in reality is that it is much harder for insurance to deny the preauth for OCD doses, whereas 80 mg of Paxil or 40 mg of Lexapro daily is the hill some local insurers have chosen to die on.

Edit: quick review of literature confirms my recollection that numerous SSRIs antagonize sigma 1, although fluvoxamine has the highest affinity. For the curious sertaline is next highest.

Really! That's interesting. I haven't started Luvox myself very frequently but have inherited a number of OCD patients who seemed to be doing well on it, so I assumed it was, like, good for that and stuff.

 

[futureapppsy2]

I remember when Trintellix came out the big thing was about it hitting the sigma 1 receptor. I know very little about the drug. Just remember that being a thing.

I think Zofran is interesting for OCD. Seems like it's usually used with an SSRI. I don't have any experience with it. I just tend to think things are interesting when they're out of the box like that. Anafranil seems to be the gold standard.

I was on Luvox once briefly. Tell patients about the caffeine interaction. Wish I had known.

Zofran, the anti-emetic?

 

[clausewitz2]

Really! That's interesting. I haven't started Luvox myself very frequently but have inherited a number of OCD patients who seemed to be doing well on it, so I assumed it was, like, good for that and stuff.

I mean, it's an SSRI, so it has a good chance of being helpful in appropriate doses. It's not not good for OCD. I think though the prescribing pattern is entirely explicable because of that FDA indication and the resulting fact it is indelibly associated with OCD in the minds of prescribers. I am someone who is sometimes willing to give some credence to clinical lore or experience in the absence of clear evidence, but in addition to nothing really in the literature none of the big deal OCD people I have ever talked to were enormously impressed by luvox.

Sort of the inverse of clomipramine, which really does seem to be far and away the most effective TCA for this indication and much better than any other to date.

 

[clausewitz2]

Zofran, the anti-emetic?

Yeah it is a thing. Like, third or fourth line, but a thing. Not a Hail Mary like...well, ondansetron/zofran for schizophrenia or nimodipine for bipolar disorder, but more like minocycline for psychotic disorders. Decent-ish evidence, inexpensive, favorable side effect profile, nobody ever seems to use it unless they're trying to publish something.

 

[birchswing]

Zofran, the anti-emetic?

Yeah, can be a risk factor for serotonin syndrome with another serotonergic drug (which I guess is true of any two serotonergic drugs) but some limited evidence showing it's very helpful for OCD and tics when taken with an SSRI. But again the SS risk, which if I recall correctly was worse with Paxil because it inhibits the 2D6 enzyme so strongly.

Edit: After I wrote Zofran I had a nagging feeling there was another weird out there thing for OCD I couldn't remember, and then I just saw on another forum someone write about it for a different reason and it reminded me: inositol. It's some sugar/B-vitamin type substance that has some evidence for helping OCD.