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OBJETIVOS
Com a leitura do presente captulo o leitor dever conhecer:
INTRODUO
Uma das descobertas mais importantes em relao ao TOC foi a de que seus sintomas
poderiam ser diminudos e at eliminados por um grupo de medicamentos que aumenta os
nveis de serotonina nas sinapses nervosas por meio da inibio de sua recaptao para
dentro do neurnio. Historicamente a clomipramina foi o primeiro medicamento com este
efeito antiobsessivo comprovado, ainda na dcada de 70. Nos anos 80 e 90 comprovou-se
tambm a eficcia dos inibidores seletivos da recaptao da serotonina (ISRS)
1-4
. Estes
no funcionam.
PSICOEDUCAO FARMACOLGICA
fluoxetina,
paroxetina,
citalopram,
sertralina
escitalopram)
Quadro 1 - Antiobsessivos
Dose diria
Dose mdia
usual - mg/dia
mg/dia
Fluoxetina
20-80
50
Fluvoxamina
100-300
200
Paroxetina
20-60
50
Sertralina
50-200
150
Citalopram
20-60
50
Escitalopram
10-30
20
Clomipramina
100-300
200
19
tratamentos farmacolgicos sem resultados. Por outro lado, antecipar aumentos de doses
pode aumentar a possibilidade de efeitos colaterais que dificultem o uso do frmaco, alm
de aumentar custos e eventualmente no representar nenhum ganho adicional.
Um mtodo mais exato de avaliar se houve ou no diminuio dos sintomas a
aplicao das escalas Y-BOCS ou OCI-R (Formulrios 3 e 4). Estas escalas podem ser
respondidas antes do inicio do medicamento e, novamente, aps um ms ou dois meses.
Comparando-se as pontuaes pode-se avaliar objetivamente os critrios de resposta,
reposta parcial ou no resposta.
que esteja atento ao reaparecimento dos sintomas. Para pacientes com 3 ou 4 episdios
de recada leve ou moderada, ou 2 a 4 recadas graves, deve-se pensar na possibilidade
de manter o tratamento por perodos maiores ou, talvez por toda a vida23. No caso de
tratamento de longo prazo, as evidncias indicam o uso continuo da dose efetiva, isto ,
doses altas25.
Os antiobsessivos no causam dependncia, o que pode ocorrer a sndrome de
descontinuao se suspensos abruptamente (o que deve ser diferenciado dos sintomas de
recada); a fluoxetina menos propensa a provocar essa reao. Alm disso, no h
problemas maiores em utiliz-los por longos perodos. importante que tanto o mdico
clnico quanto o mdico psiquiatra
medicamentos que esto sendo utilizados, pois pode haver interaes medicamentosas
significativas.
neurocirurgia.
49-51
tidas como promissoras no TOC refratrio, mas que tambm necessitam investigaes
mais sistemticas.
RESUMO E DESTAQUES
se no houve nenhuma
2)trocar
por
outro
ISRS
ou
pela
clomipramina;
3)associar
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