Dual-Diagnosis Patients Who Have Both Psychiatric Disorders and Substance Abuse Problems

BZs and tricyclic antidepressants (TCAs) should not be used in this population. BZs tend to be abused by this population (Schatzberg & Nemeroff, 2004). TCAs may have additive cardiotoxicity when they are taken with cocaine. Better choices are SSRI antidepressants or anticonvulsants (e.g., gabapentin) for anxiety symptoms.

Use of SSRIs for Obsessive-Compulsive Disorder (OCD)

Higher doses of SSRIs such as fluoxetine (Prozac) 40 to 80 mg/day, fluvoxamine (Luvox) 150 to 300 mg/day, sertraline (Zoloft) 100 to 200 mg/day, or paroxetine (Paxil) 40 to 60 mg/day can be useful. Clomipramine (Anafranil), which is also a serotonin reuptake inhibitor in the class of TCAs, can be the second-line option for SSRI nonresponders. Its poor side effect profile includes dose-related risk of seizures.