Sertraline has also been reported effective136 in longterm treatment137,138 and paroxetine (20-40 mg/day) was superior than placebo in two recent 12-week, doubleblind studies.139,110

Nefazodone (350-450 mg/day) has been shown to significantly improve most, symptoms, including intrusive thoughts, avoidant behaviors, Inhibitors,research,lifescience,medical emotional numbing, nightmares, sleep, depression, and anger,141,142 and there is only anecdotal evidence for improvement with trazodone.123 Other drugs The anticonvulsant carbamazepine has been shown to decrease flashbacks, hyperarousal, and impulsivity.143,144 Lithium and valproic acid may be helpful as well,145-147 particularly in patients with poor impulse control.148 Inhibitors,research,lifescience,medical Open-label topiramate149 and gabapentin150 appeared effective as add-on therapy for chronic PTSD. Buspirone (15-35 mg/day) was reported to be effective in reducing anxiety, insomnia, flashbacks, and depressed mood in three PTSD war veterans after 2 weeks of treatment.151 Some case IPA 3 reports with atypical neuroleptics and an open-label study with olanzapine have been positive for the treatment of the

core symptoms and the psychotic symptoms that PTSD patients may exhibit.123,152 Open-label propranolol (120-160 mg/day) improved hyperarousal, Inhibitors,research,lifescience,medical sleep, nightmares, explosiveness, and psychosocial functioning in 11 out of 12 Vietnam veterans,153 and acute, posttrauma propranolol may have a preventive effect on subsequent PTSD.154 The α1-adrenergic antagonist prazosin155 and α2-adrenergic agonists clonidine and guanfacine also provided Inhibitors,research,lifescience,medical some preliminary promising results.123,153 Obsessive-compulsive disorder Benzodiazepines BZs are not a first-choice treatment for OCD (Table V), and few data exist, to date. Clonazepam, a BZ that, also affects serotonergic transmission, Inhibitors,research,lifescience,medical was compared with clomipramine and clonidine in a crossover, double-blind study with each treatment lasting

for 6 weeks.156 The first two drugs were equally effective, while clonidine was largely ineffective. Clonazepam provided an early improvement (2-3 weeks), unrelated to changes in anxiety, and there was a significant cross-response between clomipramine and clonazepam, with patients who failed on clomipramine showing a clinically significant response to clonazepam. Table V. Obsessive-compulsive Oxymatrine disorder (OCD): therapeutic strategies. BZ, benzodiazepine; MAOI, monoamine oxidase inhibitor; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricylic antidepressant. Antidepressants Pharmacological investigations have demonstrated that OCD responds selectively to drugs that act as potent inhibitors of the synaptic reuptake of serotonin.