Fluvoxamine Monotherapy Research Articles

Rhabdomyolysis in a male adolescent associated with monotherapy of fluvoxamine

Rhabdomyolysis is a syndrome resulting from striated muscular breakdown, which may occur due to drug therapy with agents such as selective serotonin reuptake inhibitors (SSRIs). Although studies have shown that...

The Effects of Demographic Characteristics, Memory Deficits, and Executive Functioning Impairments in Failure to Respond to Fluvoxamine among Patients with Obsessive-Compulsive Disorder in Iran

Background: Identifying treatment-response predictors could help improve treatment protocols as well as appropriately tailoring them to each subject, leading to a more desirable and accelerated recovery in patients. Thus, the present study aimed to investigate the role of demographic characteristics, memory deficits, and executive functioning impairments in failure to respond to fluvoxamine among patients with obsessive-compulsive disorder (OCD). Methods: This 2-group design (treatment-responsive and treatment-resistant) experimental study explored 76 participants who had received fluvoxamine monotherapy for OCD for ≥6 months. The study participants were from Iran. Four data collection tools were used in this study (ie, Demographic Data Form, WMS-III, WCST, and Y-BOCS). The achieved data were analyzed in SPSS-16 by descriptive statistics, such as mean and standard deviation and frequency and percentages, as well as an independent samples t-test, a chi-square test, and a Fisher exact test at P <0.05. Results: The present study findings indicated that 56 (81.2%) out of 76 patients with OCD responded to fluvoxamine treatment. A significant difference between the study groups highlighted age as an influential factor in providing a positive therapeutic response to fluvoxamine (P=0.048). However, the groups did not significantly differ in terms of gender (P=0.272), marital status (P=0.753), educational level (P=0.332), disease duration (P=0.276), and occupational status (P=0.473). While there was no significant difference between the groups (P=0.639) in terms of memory deficits (P=0.639), the response rate to fluvoxamine treatment was significantly higher in those with a healthy executive functioning, compared with patients with impairments in this respect (P=0.043). Conclusion: The obtained data suggested that fluvoxamine has a favorable efficacy in the treatment of OCD, and especially in young patients with healthy executive functioning.

Oxidative Stress and Poststroke Depression

Objective. To study the use of combined therapy of poststroke depression using antidepressants and an antioxidant. Materials and methods. The dynamics of the clinical status of poststroke depression and parameters of oxidative stress were studied in 60 patients with poststroke depression before and after threemonth courses of treatment with fluvoxamine 100 mg/day and Cytoflavin 10 mg/day by i.v. infusion diluted in 200 ml of 5% glucose solution (or physiological saline in patients with diabetes mellitus) in the mornings for 10 days with subsequent transfer to the tableted form (two tablets in the morning and two in the evening for 90 days). Results. The data obtained here on the comparative efficacy of the treatment of poststroke depression with fluvoxamine monotherapy and with the combination of fluvoxamine and Cytoflavin confirmed the high efficacy of combined treatment, such that this should be regarded as an option in developing novel treatment regimes for poststroke depression and that the need to prescribe antidepressants and antioxidants must be determined on the basis of individual assessment of the severity of depressive disorder and measures of oxidative stress in terms of the activity of endogenous antioxidants in each individual poststroke patient.

Fluvoxamine induced oculogyric dystonia and manic switch in a patient with obsessive compulsive disorder

Fluvoxamine has a similar spectrum of adverse effects as compared to other selective serotonin reuptake inhibitors. However, fluvoxamine induced oculogyric dystonia is a rare instance in clinical practice. In this report, we present a case of obsessive compulsive disorder that developed oculogyric dystonia during the course of fluvoxamine mono-therapy and subsequently had a manic switch.

P-820 - Benefits of fluvoxamine and olanzapine combination among adolescents with resistance OCD

Although antipsychotics are commonly employed in treatment augmentation strategies for severe obsessive-compulsive disorder (OCD) among adolescents, the role of atypical neuroleptics is still unclear (1.2.). Since our clinical practice suggest that in some cases small amount of olanzapine was helpful for patient with resistance to SSRI mono therapy (specially added to fluvoxamine mono therapy) we tested the hypothesis that olanzapine augmentation would be beneficial in treatment-unresponsive OCD. 8-week trial, we recruited 11 adolescents (mean age 14,7) with OCD (DSM-IV criteria), unresponsive to Fluvoxamine (≥100 mg/day) for ≥ 10 weeks, which was continued throughout the trial. Subjects had OCD for ≥ 2 year, a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score typically was of ≥ 18, and no other primary Axis I disorder is exist. After 10 week Fluvoxamine therapy Olanzapine was added in minimal therapeutic amount of 2,5 mg daily. After 6 week combination therapy the symptoms was evaluated by Y-BOCS. Preliminary analyses of data of these patients demonstrate a statistically and clinically significant improvement in OCD symptoms (50%–60% mean improvement in general, Y-BOCS scores dropped 68%, 30%, and 30%,). Combo treatment for adolescents was well tolerated and safety.

The opposite effects of fluvoxamine and sertraline in the treatment of psychotic major depression: a case report

BackgroundPsychotic major 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 (ECT) in treating psychotic major depression. In several studies, monotherapy of SSRIs such as fluvoxamine has been shown to be effective in the treatment of psychotic major depression.MethodsWe report on a 36-year-old Japanese woman in whom fluvoxamine (a SSRI with sigma-1 receptor agonist) and sertraline (a SSRI with sigma-1 receptor antagonist) showed the opposite effects on psychotic symptoms in the treatment of psychotic major depression.ResultsSymptoms of depression and psychosis in the patient who was non-respondent to antipsychotic drugs improved after fluvoxamine monotherapy. At 3 years later, a switch to sertraline from fluvoxamine dramatically worsened the psychotic symptoms in the patient. Then, a switch back to fluvoxamine from sertraline improved these symptoms 1 week after fluvoxamine treatment.ConclusionDoctors should consider the monotherapy of sigma-1 receptor agonist fluvoxamine as an alternative approach to treating psychotic major depression.

Fluvoxamine monotherapy for psychotic depression: the potential role of sigma-1 receptors

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.

Topiramate Versus Fluvoxamine in the Treatment of Pathological Gambling

Pathologic gambling (PG) is a highly prevalent and disabling impulse control disorder. Recent studies have demonstrated that PG patients respond well to treatment with SSRIs, mood stabilizers, and opioid antagonists. These findings support the idea that PG and other disorders of impulse control may be conceptualized as part of the obsessive-compulsive spectrum disorders. Pilot studies have shown topiramate to be effective in the treatment of specific disorders of impulse control. The aim of the study is to compare the effectiveness of topiramate versus fluvoxamine in the treatment of PG. Thirty-one male PGs were assigned in a randomized fashion to receive either topiramate (15/31) or fluvoxamine (16/31) pharmacotherapy for 12 weeks. A comprehensive psychiatric diagnostic evaluation was performed on all patients, and all patients were evaluated for symptoms of gambling, depression, and anxiety using the South Oaks Gambling Screen, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Yale-Brown Obsessive Compulsive Symptoms Scale, and the Clinical Global Impression-Improvement Scale. The rating scales were administered at baseline and at the 12-week endpoint. In addition, the patients completed self-report questionnaires about their demographic status. Twelve of the 15 patients from the topiramate group completed the 12-week treatment. Nine of the 12 topiramate completers reported full remission of gambling behavior, and 3 completers had a partial remission. The CGI-improvement score was significantly better for the topiramate group at the 12-week visit as compared with baseline (F = 10.5, P < 0.01, df = 2.31). In the fluvoxamine treatment group 8/16 patients completed the study, and 6/8 fluvoxamine completers reported a full remission, and the remaining 2/8 fluvoxamine completers reported a partial remission. The fluvoxamine group showed improvement in the CGI-improvement score at week 12, although this difference was not significant (F = 3.7, P < 0.08, df = 2.31). Topiramate and fluvoxamine monotherapy may be effective in the treatment of pathologic gambling.

Low-dose risperidone augmentation of fluvoxamine treatment in obsessive-compulsive disorder: a double-blind, placebo-controlled study

According to previous data, the addition of risperidone in obsessive-compulsive patients refractory to serotonin reuptake inhibitors (SRIs) is shown to be a safe and effective treatment strategy. The aims of our study were to evaluate the efficacy of risperidone addition, in comparison to placebo, in fluvoxamine-refractory obsessive-compulsive patients and to investigate whether risperidone could boost the efficacy of fluvoxamine in fluvoxamine-responder patients. Subjects were 45 obsessive-compulsive inpatients, consecutively recruited at the Department of Neurosciences at the San Raffaele Hospital, Milan. Thirty-nine patients completed the study. All patients received 12 weeks of a standardized open-label fluvoxamine monotherapy and then continued for 6 weeks with placebo or risperidone in a double-blind design. Results showed a significant effect of risperidone addition, at the end of the double-blind phase (18th week), only for fluvoxamine-refractory patients. Five patients on risperidone (50%) and two (20%) on placebo became responders, with a Yale–Brown Obsessive-Compulsive Scale (Y–BOCS) decrease ≥35%. Risperidone was generally well tolerated, except for a mild transient sedation and a mild increase in appetite. This preliminary study suggests that even very low (0.5 mg) risperidone doses are effective in OC patients who were nonresponders to a standardized treatment with fluvoxamine.

The influence of lithium on fluvoxamine therapeutic efficacy and pharmacokinetics in depressed patients on combined fluvoxamine—lithium therapy

The influence of lithium on fluvoxamine therapeutic efficacy, plasma concentrations and pharmacokinetics was studied in 12 depressed inpatients. Six patients were on fluvoxamine monotherapy and six were on combined fluvoxamine-lithium therapy. The treatment response was determined using 17-item Hamilton Rating Scale for Depression. Blood samples were collected during 48 h after a single dose administration of 100 mg fluvoxamine, and five times at steady state after repeated doses of 100 mg fluvoxamine per day. The evaluation of 17-item Hamilton Rating Scale for Depression Scores showed a significant clinical improvement 2 and 4 weeks after the beginning of the therapy in both groups (p < 0.01). However, 2 weeks after the administration of the drug(s) had started, significant differences (p < 0.05) in efficacy between the two treatments in favour of the fluvoxamine-lithium combination were found. Plasma concentrations of fluvoxamine were measured by high-performance liquid chromatography. The comparison of the measured concentrations of fluvoxamine showed a similar course of the plasma concentration-time curves in both groups of patients. Pharmacokinetic parameters of fluvoxamine did not show any significant difference on the comparison between the groups. According to the results from this study, it is evident that lithium does not affect plasma concentrations and pharmacokinetics of fluvoxamine in depressed patients on concomitant treatment with these two drugs. However, the effect achieved with the combination was better.

5HT‐2 receptor and fluvoxamine effect in obsessive‐compulsive disorder

AbstractThe aim of the study was to test the role of the 5HT‐2 receptor in the antiobsessional effect of 5HT uptake inhibitors. For this purpose we designed a double blind controlled clinical trial, in which ritanserin (a specific 5HT‐2 receptor antagonist) or placebo were administered to a sample of 10 patients affected by Obsessive Compulsive Disorder (OCD), symptomatologically stabilized during fluvoxamine monotherapy. In order to quantify OCD symptom severity we used the Yale Brown Obsessive Compulsive Scale (Y‐BOCS), administered weekly for the 14 days of the study. One way Analysis of Variance (ANOVA), performed on Y‐BOCS total scores, showed a significant difference between the two treatment groups. The difference between ritanserin and placebo effect seemed to be related either to the slight worsening of the ritanserin group, or to the improvement in the placebo one. These results suggest that 5HT‐2 receptor may be involved in the antiobsessional effect of fluvoxamine.