fluvoxamine and Affective-Disorders--Psychotic

Previous studies have reported the efficacy of selective serotonin reuptake inhibitors as monotherapy in the treatment of delusional depression. The clinical efficacy of venlafaxine, a serotonin-norepinephrine reuptake blocker, has been demonstrated in the treatment of patients with moderate-to-severe depression, but, to date, no evidence is available about its use in depressed patients with psychotic features.. Under double-blind conditions, 28 hospitalized patients who met DSM-IV criteria for major depression, severe with psychotic features, were randomly assigned to receive fluvoxamine or venlafaxine, 300 mg/day, for 6 weeks. Severity was evaluated using the Hamilton Rating Scale for Depression (HAM-D) and the Dimensions of Delusional Experience Rating Scale (DDERS) administered at baseline and every week thereafter. Side effects were also recorded. Clinical response was defined as a reduction of the scores in the 21-item HAM-D to 8 or below and in the DDERS to 0.. At study completion, the response rates were 78.6% (N = 11) and 58.3% (N = 7) for fluvoxamine and venlafaxine, respectively. No significant difference was found between drugs (Fisher exact test, p = .40). Analysis of covariance on HAM-D scores did not reveal a significantly different decrease of depressive symptomatology between the 2 treatment groups (p = .14). Treatment response appeared to be unrelated to the demographic and clinical characteristics recorded. The overall safety profile of both fluvoxamine and venlafaxine was favorable.. The results of this pilot double-blind trial show that fluvoxamine is useful in the treatment of delusional depression and suggest that venlafaxine may also be an effective compound in the treatment of this disorder. The latter finding, although promising, warrants further replication in a larger sample of patients.

Topics: Adult; Affective Disorders, Psychotic; Cyclohexanols; Delusions; Depressive Disorder; Double-Blind Method; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Pilot Projects; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Venlafaxine Hydrochloride

The aim of this open pilot study was to evaluate the efficacy of fluvoxamine in the continuation as well as in the maintenance therapy of delusional depression. Thirty patients with recurrent, unipolar depression (DSM-IV criteria) were selected who had at least one depressive episode during the 18 months preceding the delusional depressive index episode and were treated with fluvoxamine 300 mg/day. Twenty-five of them had a sustained response to this short-term treatment and agreed to enter into the 30-month follow up study. All participants completed the follow up period. No relapse was observed during the 6 months of continuation therapy. During the further 24 months of maintenance therapy, 80% of the patients remained well, whereas 20% (five out of 25) had a single recurrence. Based on these observations, fluvoxamine might be a promising drug for long-term therapy of delusional depression. Further controlled studies are required to confirm this finding.

Topics: Adult; Affective Disorders, Psychotic; Antidepressive Agents, Second-Generation; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Selective Serotonin Reuptake Inhibitors

Akathisia is a syndrome characterized by the unpleasant sensation of "inner" restlessness that manifests itself in the inability of sitting still or not moving. Many types of medicaments can cause akathisia as an adverse event of their use and they include: antipsychotics, antidepressants, antiemetics, antihistamines, and psychoactive substances. We will present the case of a 50 year old patient, treated on two occasions for psychotic depression. During the second hospitalization it is possible that antipsychotic treatment combined with an antidepressant caused akathisia or there were symptoms of agitated depression and akathisia present at the same time, which is very difficult to determine in everyday clinical practice. We can conclude that in this case, as in many others, akathisia as a possible adverse effect of psychopharmacs was very hard to identify. Therefore, it is necessary to have akathisia in mind when using certain medicaments, especially when combining several that use the same enzymatic system and consequently raise levels of at least one of them.

Topics: Affective Disorders, Psychotic; Akathisia, Drug-Induced; Anticonvulsants; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Depressive Disorder; Diagnosis, Differential; Diagnostic Errors; Dibenzothiazepines; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Middle Aged; Olanzapine; Psychomotor Agitation; Quetiapine Fumarate; Valproic Acid

Topics: Adult; Affective Disorders, Psychotic; Antipsychotic Agents; Breast Feeding; Depression, Postpartum; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Fluvoxamine; Humans; Pregnancy; Pregnancy Complications; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors

Out of ten consecutive patients with DSM-III-R obsessive-compulsive disorder without any previous history of bipolarity, three patients showed antidepressant-induced hypomania (clomipramine, one patient; fluvoxamine, two patients) within the first 5 to 8 weeks of the drug treatment. These data support the previous results on a strong association between obsessive-compulsive disorder and bipolar affective illness.

Topics: Adolescent; Adult; Affective Disorders, Psychotic; Antidepressive Agents; Clomipramine; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors