<unk>  has been approved for major depressive disorder (MDD), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, and social anxiety disorder (SAD).<unk>  is not approved for use in children except for those with OCD. Depression Multiple controlled clinical trials established efficacy of<unk>  for the treatment of depression.<unk>  is also an effective antidepressant in the routine clinical practice. Continued treatment with<unk>  prevents both a relapse of the current depressive episode and future episodes (recurrence of depression). In several double-blind studies,<unk>  was consistently more effective than placebo for dysthymia, a more chronic variety of depression, and comparable to imipramine in that respect.<unk>  also improves the depression of dysthymic patients to a greater degree than psychotherapy. Limited pediatric data also demonstrates reduction in depressive symptoms in the pediatric population though remains a second line therapy after fluoxetine. Comparison with other antidepressants In general,<unk>  efficacy is similar to that of other antidepressants. For example, a meta-analysis of 12 new-generation antidepressants showed that<unk>  and escitalopram are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with depression. Comparative clinical trials demonstrated that<unk>  is similar in efficacy against depression to moclobemide, nefazodone, escitalopram, bupropion, citalopram, fluvoxamine, paroxetine, venlafaxine and mirtazapine.<unk>  may be more efficacious for the treatment of depression in the acute phase (first 4 weeks) than fluoxetine. There are differences between<unk>  and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. For severe depression,<unk>  is as good as clomipramine but is better tolerated.<unk>  appears to work better in melancholic depression than fluoxetine, paroxetine, and mianserin and is similar to the tricyclic antidepressants such as amitriptyline and clomipramine. In the treatment of depression accompanied by OCD,<unk>  performs significantly better than desipramine on the measures of both OCD and depression.<unk>  is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated. Compared with amitriptyline,<unk>  offered a greater overall improvement in quality of life of depressed patients. Depression in elderly<unk>  used for the treatment of depression in elderly (older than 60) patients is superior to placebo and comparable to another SSRI fluoxetine, and tricyclic antidepressants (TCAs) amitriptyline, nortriptyline and imipramine.<unk>  has much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurs more frequently with<unk> . In addition,<unk>  appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. Accordingly, a meta-analysis of antidepressants in older adults found that<unk> , paroxetine and duloxetine were better than placebo. On the other hand, in a 2003 trial the effect size was modest, and there was no improvement in quality of life as compared to placebo. With depression in dementia, there is no benefit of<unk>  treatment compared to either placebo or mirtazapine. Obsessive–compulsive disorder<unk>  is effective for the treatment of OCD in adults and children. It was better tolerated and, based on intention-to-treat analysis, performed better than the gold standard of OCD treatment clomipramine. Continuing<unk>  treatment helps prevent relapses of OCD with long-term data supporting its use for up to 24 months. It is generally accepted that the<unk>  dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression. The onset of action is also slower for OCD than for depression. The treatment recommendation is to start treatment with a half of maximal recommended dose for at least two months. After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response. Cognitive behavioral therapy alone was superior to<unk>  in both adults and children; however, the best results were achieved using a combination of these treatments. Panic disorder<unk>  is superior to placebo for the treatment of panic disorder. The response rate was independent of the dose. In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety,<unk>  resulted in improvement of quality of life on most parameters. The patients rated as "improved" on<unk>  reported better quality of life than the ones who "improved" on placebo. The authors of the study argued that the improvement achieved with<unk>  is different and of a better quality than the improvement achieved with placebo.<unk>  is equally effective for men and women, and for patients with or without agoraphobia. Previous unsuccessful treatment with benzodiazepines does not diminish its efficacy. However, the response rate was lower for the patients with more severe panic. Starting treatment simultaneously with<unk>  and clonazepam, with subsequent gradual discontinuation of clonazepam, may accelerate the response. Double-blind comparative studies found<unk>  to have the same effect on panic disorder as paroxetine or imipramine. While imprecise, comparison of the results of trials of<unk>  with separate trials of other anti-panic agents (clomipramine, imipramine, clonazepam, alprazolam, and fluvoxamine) indicates approximate equivalence of these medications. Other anxiety disorders<unk>  has been successfully used for the treatment of social anxiety disorder. All three major domains of the disorder (fear, avoidance, and physiological symptoms) respond to<unk> . Maintenance treatment, after the response is achieved, prevents the return of the symptoms. The improvement is greater among the patients with later, adult onset of the disorder. In a comparison trial,<unk>  was superior to exposure therapy, but patients treated with the psychological intervention continued to improve during a year-long follow-up, while those treated with<unk>  deteriorated after treatment termination. The combination of<unk>  and cognitive behavioral therapy appears to be more effective in children and young people than either treatment alone.<unk>  has not been approved for the treatment of generalized anxiety disorder; however, several guidelines recommend it as a first-line medication referring to good quality controlled clinical trials. Premenstrual dysphoric disorder<unk>  is effective in alleviating the symptoms of premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome. Significant improvement was observed in 50–60% of cases treated with<unk>  vs. 20–30% of cases on placebo. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity and general quality of life. Work functioning and physical symptoms, such as swelling, bloating and breast tenderness, were less responsive to<unk> . Taking<unk>  only during the luteal phase, that is, the 12–14 days before menses, was shown to work as well as continuous treatment. Continuous treatment with sub-therapeutic doses of<unk>  (25 mg vs. usual 50–100 mg) is also effective. Other indications<unk>  is approved for the treatment of post-traumatic stress disorder (PTSD). National Institute of Clinical Excellence recommends it for patients who prefer drug treatment to a psychological one. Other guidelines also suggest<unk>  as a first-line option for pharmacological therapy. When necessary, long-term pharmacotherapy can be beneficial. There are both negative and positive clinical trial results for<unk> , which may be explained by the types of psychological traumas, symptoms, and comorbidities included in the various studies. Positive results were obtained in trials that included predominantly women (75%) with a majority (60%) having physical or sexual assault as the traumatic event. Contrary to the above suggestions, a meta-analysis of<unk>  clinical trials for PTSD found it to be not significantly better than placebo. Another meta-analysis relegated<unk>  to the second line, proposing trauma focused psychotherapy as a first-line intervention. The authors noted that Pfizer had declined to submit the results of a negative trial for the inclusion into the meta-analysis making the results unreliable.<unk>  when taken daily can be useful for the treatment of premature ejaculation. A disadvantage of<unk>  is that it requires continuous daily treatment to delay ejaculation significantly. A 2019 systematic review suggested that<unk>  may be a good way to control anger, irritability and hostility in depressed patients and patients with other comorbidities.
Sertraline
Citalopram
Escitalopram
Clomipramine
Trimipramine
Mirtazapine
Asenapine
Quetiapine