Sometimes there are clinical trials and the dosage may be increased. However, from my experience, very few family doctors are aware or up to date on such matters since it does fall under psychiatry.
Obsessive-Compulsive Disorder (OCD)
The effectiveness of Zoloft in the treatment of OCD was demonstrated in three multicenter placebo-controlled studies of adult outpatients (Studies 1–3). Patients in all studies had moderate to severe OCD (DSM-III or DSM-III-R) with mean baseline ratings on the Yale–Brown Obsessive-Compulsive Scale (YBOCS) total score ranging from 23 to 25.
Study 1 was an 8-week study with flexible dosing of Zoloft in a range of 50 to 200 mg/day; the mean dose for completers was 186 mg/day. Patients receiving Zoloft experienced a mean reduction of approximately 4 points on the YBOCS total score which was significantly greater than the mean reduction of 2 points in placebo-treated patients.
Study 2 was a 12-week fixed-dose study, including Zoloft doses of 50, 100, and 200 mg/day. Patients receiving Zoloft doses of 50 and 200 mg/day experienced mean reductions of approximately 6 points on the YBOCS total score which were significantly greater than the approximately 3 point reduction in placebo-treated patients.
Study 3 was a 12-week study with flexible dosing of Zoloft in a range of 50 to 200 mg/day; the mean dose for completers was 185 mg/day. Patients receiving Zoloft experienced a mean reduction of approximately 7 points on the YBOCS total score which was significantly greater than the mean reduction of approximately 4 points in placebo-treated patients.
Analyses for age and gender effects on outcome did not suggest any differential responsiveness on the basis of age or sex.
The effectiveness of Zoloft for the treatment of OCD was also demonstrated in a 12-week, multicenter, placebo-controlled, parallel group study in a pediatric outpatient population (children and adolescents, ages 6–17). Patients receiving Zoloft in this study were initiated at doses of either 25 mg/day (children, ages 6–12) or 50 mg/day (adolescents, ages 13–17), and then titrated over the next four weeks to a maximum dose of 200 mg/day, as tolerated. The mean dose for completers was 178 mg/day. Dosing was once a day in the morning or evening. Patients in this study had moderate to severe OCD (DSM-III-R) with mean baseline ratings on the Children's Yale-Brown Obsessive-Compulsive Scale (CYBOCS) total score of 22. Patients receiving sertraline experienced a mean reduction of approximately 7 units on the CYBOCS total score which was significantly greater than the 3 unit reduction for placebo patients. Analyses for age and gender effects on outcome did not suggest any differential responsiveness on the basis of age or sex.
In a longer-term study, patients meeting DSM-III-R criteria for OCD who had responded during a 52-week single-blind trial on Zoloft 50–200 mg/day (n=224) were randomized to continuation of Zoloft or to substitution of placebo for up to 28 weeks of observation for discontinuation due to relapse or insufficient clinical response. Response during the single-blind phase was defined as a decrease in the YBOCS score of ≥ 25% compared to baseline and a CGI-I of 1 (very much improved), 2 (much improved) or 3 (minimally improved). Relapse during the double-blind phase was defined as the following conditions being met (on three consecutive visits for 1 and 2, and for visit 3 for condition 3): (1) YBOCS score increased by ≥ 5 points, to a minimum of 20, relative to baseline; (2) CGI-I increased by ≥ one point; and (3) worsening of the patient's condition in the investigator's judgment, to justify alternative treatment. Insufficient clinical response indicated a worsening of the patient's condition that resulted in study discontinuation, as assessed by the investigator. Patients receiving continued Zoloft treatment experienced a significantly lower rate of discontinuation due to relapse or insufficient clinical response over the subsequent 28 weeks compared to those receiving placebo. This pattern was demonstrated in male and female subjects.
- Zoloft Information for Consumers
- Zoloft Information for Healthcare Professionals (includes dosage details)
- Side Effects of Zoloft (detailed)
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