Abstract
BackgroundPsychotic depression is a clinical subtype of major depressive disorder. A number of clinical studies have demonstrated the efficacy of the combination of an antidepressant (for example, a tricyclic antidepressant or selective serotonin reuptake inhibitor (SSRI)) and an atypical antipsychotic or electroconvulsive therapy in treating psychotic depression. In some cases, the clinician or patient may prefer to avoid antipsychotic drugs altogether because of the risk of extrapyramidal side effects (EPS) in patients with psychotic depression treated with these drugs.MethodsWe report five cases where fluvoxamine monotherapy was effective in the patients with psychotic depression.ResultsThe scores on the Hamilton Depression (HAM-D) scale and the Brief Psychiatric Rating Scale (BPRS) in the five patients with psychotic depression were reduced after fluvoxamine monotherapy.ConclusionDoctors should consider fluvoxamine monotherapy as an alternative approach in treating psychotic depression because it avoids the risk of EPS from antipsychotic drugs.
Highlights
Psychotic depression is a clinical subtype of major depressive disorder
We report five cases in which fluvoxamine monotherapy was effective in Japanese patients with psychotic depression
Further studies using large numbers of patients are needed before it can be concluded that fluvoxamine monotherapy is effective in patients with psychotic depression
Summary
Psychotic depression is a clinical subtype of major depressive disorder and is characterized by psychosis accompanied by relatively severe depressive symptoms that include psychomotor impairment, morbid cognition, suicidal ideation and neuropsychological impairment. By 2 weeks later, her activity levels had recovered Her HAM-D and BPRS scores had dramatically decreased (Table 1), and she was discharged home 3 weeks after beginning treatment with fluvoxamine. Fluvoxamine (50 mg twice a day), flunitrazepam (2 mg), and etizolam (0.5 mg) were initiated, and the day, fluvoxamine was increased to 100 mg His HAM-D and BPRS scores dramatically decreased (Table 1), and he was discharged home 17 days after beginning treatment with fluvoxamine. By 3 weeks later, her paranoia and delusion had disappeared Her HAM-D and BPRS scores had decreased (Table 1) and she was discharged home 4 weeks after the beginning of treatment with fluvoxamine
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