<unk>  blister pack 20 mg capsules<unk>  10 mg tablets<unk>  is frequently used to treat major depressive disorder, obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bulimia nervosa, panic disorder, premenstrual dysphoric disorder, and trichotillomania. It has also been used for cataplexy, obesity, and alcohol dependence, as well as binge eating disorder.<unk>  seems to be ineffective for social anxiety disorder. Studies do not support a benefit in children with autism, though there is tentative evidence for its benefit in adult autism.<unk>  together with<unk> uvoxamine has shown some initial promise as a potential treatment for reducing COVID-19 severity if given early. Depression Efficacy of<unk>  for acute and maintenance treatment of major depressive disorder in adults as well as children and adolescents (8 to 18 years) was established in multiple clinical trials. In addition to being effective for depression in 6-week long double-blind controlled trials,<unk>  was better than placebo for the prevention of depression recurrence, when the patients, who originally responded to<unk> , were treated for a further 38 weeks. Efficacy of<unk>  for geriatric as well as pediatric depression was also demonstrated in placebo-controlled trials.<unk>  is as effective as tricyclic antidepressants but is better tolerated. According to a network analysis of clinical trials,<unk>  may belong to the group of less effective antidepressants; however, its acceptability is higher than any other antidepressant, except agomelatine. Obsessive–compulsive disorder The efficacy of<unk>  in the treatment of obsessive–compulsive disorder (OCD) was demonstrated in two randomized multicenter phase III clinical trials. The pooled results of these trials demonstrated that 47% of completers treated with the highest dose were "much improved" or "very much improved" after 13 weeks of treatment, compared to 11% in the placebo arm of the trial. The American Academy of Child and Adolescent Psychiatry state that SSRIs, including<unk> , should be used as first-line therapy in children, along with cognitive behavioral therapy (CBT), for the treatment of moderate to severe OCD. Panic disorder The efficacy of<unk>  in the treatment of panic disorder was demonstrated in two 12-week randomized multicenter phase III clinical trials that enrolled patients diagnosed with panic disorder, with or without agoraphobia. In the first trial, 42% of subjects in the<unk> -treated arm were free of panic attacks at the end of the study, vs. 28% in the placebo arm. In the second trial, 62% of<unk>  treated patients were free of panic attacks at the end of the study, vs. 44% in the placebo arm. Bulimia nervosa A 2011 systematic review discussed seven trials which compared<unk>  to a placebo in the treatment of bulimia nervosa, six of which found a statistically significant reduction in symptoms such as vomiting and binge eating. However, no difference was observed between treatment arms when<unk>  and psychotherapy were compared to psychotherapy alone. Premenstrual dysphoric disorder<unk>  is used to treat premenstrual dysphoric disorder, a condition where individuals have affective and somatic symptoms monthly during the luteal phase of menstruation. Taking<unk>  20 mg/d can be effective in treating PMDD, though doses of 10 mg/d have also been prescribed effectively. Impulsive aggression<unk>  is considered a first-line medication for the treatment of impulsive aggression of low intensity.<unk>  reduced low intensity aggressive behavior in patients in intermittent aggressive disorder and borderline personality disorder.<unk>  also reduced acts of domestic violence in alcoholics with a history of such behavior. Special populations In children and adolescents,<unk>  is the antidepressant of choice due to tentative evidence favoring its efficacy and tolerability. In pregnancy,<unk>  is considered a category C drug by the US Food and Drug Administration (FDA). Evidence supporting an increased risk of major fetal malformations resulting from<unk>  exposure is limited, although the Medicines and Healthcare products Regulatory Agency (MHRA) of the UK has warned prescribers and patients of the potential for<unk>  exposure in the first trimester (during organogenesis, formation of the fetal organs) to cause a slight increase in the risk of congenital cardiac malformations in the newborn. Furthermore, an association between<unk>  use during the first trimester and an increased risk of minor fetal malformations was observed in one study. However, a systematic review and meta-analysis of 21 studies – published in the Journal of Obstetrics and Gynaecology Canada – concluded, "the apparent increased risk of fetal cardiac malformations associated with maternal use of<unk>  has recently been shown also in depressed women who deferred SSRI therapy in pregnancy, and therefore most probably reflects an ascertainment bias. Overall, women who are treated with<unk>  during the first trimester of pregnancy do not appear to have an increased risk of major fetal malformations." Per the FDA, infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn. Limited data support this risk, but the FDA recommends physicians consider tapering SSRIs such as<unk>  during the third trimester. A 2009 review recommended against<unk>  as a first-line SSRI during lactation, stating,<unk>  should be viewed as a less-preferred SSRI for breastfeeding mothers, particularly with newborn infants, and in those mothers who consumed<unk>  during gestation." Sertraline is often the preferred SSRI during pregnancy due to the relatively minimal fetal exposure observed and its safety profile while breastfeeding.
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