fluvoxamine and Agoraphobia

Topics: Agoraphobia; Cognitive Behavioral Therapy; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Fluvoxamine; Humans; Panic Disorder; Paroxetine; Reference Standards; Selective Serotonin Reuptake Inhibitors

Two years after completion of a controlled outcome study of treatments for panic disorder with agoraphobia, patients were revisited and interviewed about their complaints. In the initial study, four treatments had been compared: (i) fluvoxamine combined with exposure; (ii) placebo medication plus exposure; (iii) psychological panic management plus exposure; and (iv) exposure alone. Comparison of the results at post-test had revealed superior efficacy of fluvoxamine combined with exposure over the other three treatments in reducing agoraphobic avoidance. The current naturalistic follow-up study investigated the long-term efficacy of the treatments with regard to abatement of complaints and reduced demand for further treatment. In addition, we examined whether patients were able to taper off the study medication without a recurrence of complaints. In total, 71 of the 76 patients of the original trial (93%) were interviewed. Comparison of the mean level of psychopathology at follow-up revealed no difference between the original treatment groups. The effect in the fluvoxamine plus exposure group was maintained, but was no longer superior, due to further improvements in the other treatment groups. Most patients received additional treatment during the follow-up period, usually because the 12 treatment sessions in the controlled study had yielded insufficient improvement. There was a trend for patients who received the fluvoxamine plus exposure treatment to require less aftercare than those who received the other treatments. Finally, almost 50% of the patients who had received medication in the original trial were able to taper off the use of fluvoxamine without a recurrence of complaints.

Topics: Agoraphobia; Benzodiazepines; Fluvoxamine; Follow-Up Studies; Humans; Panic Disorder; Psychotherapy; Surveys and Questionnaires; Time Factors; Treatment Outcome

Panic disorder, with and without agoraphobia, is a prevalent condition which presents primarily in general practice. Previous clinical outcome studies have been conducted mainly in specialist university departments or hospital settings, and have tended to employ complex rating scales that are not well suited for use as outcome measures in primary care.. To evaluate the outcome, in a primary care setting, of fluvoxamine versus cognitive behaviour therapy, each used alone and in combination in a double-blind placebo-controlled framework, balanced for therapist contact.. A total of 149 patients satisfying DSMIII-R criteria for panic disorder were randomly allocated to receive one of the following: fluvoxamine, placebo, fluvoxamine plus cognitive behaviour therapy, placebo plus cognitive behaviour therapy, and cognitive behaviour therapy alone. These five treatment groups represent the minimum number acceptable for such a comparison to be made. All patients received an identical schedule of contact over 13 weeks. Measures of symptom severity, general health and social disruption were taken at entry point and end point; measures of change in symptoms were taken at end point only. Outcome was reported in terms of brief global ratings of severity of illness and change in symptoms, and of ratings of general health and social disruption that are suitable for use in general practice.. All active treatment groups showed statistically significant advantages over placebo over a range of outcome ratings. The groups employing cognitive behaviour therapy showed the most robust and consistent response.. The brief global measures reported here proved adequate to the task of assessing treatment outcome. Results indicate that treatments including cognitive behaviour therapy can be effective in the treatment of panic disorder and agoraphobia in primary care.

Topics: Adolescent; Adult; Aged; Agoraphobia; Cognitive Behavioral Therapy; Combined Modality Therapy; Double-Blind Method; Family Practice; Female; Fluvoxamine; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Panic Disorder; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Topics: Adolescent; Adult; Aged; Agoraphobia; Analysis of Variance; Behavior Therapy; Benzodiazepines; Combined Modality Therapy; Comorbidity; Depressive Disorder; Double-Blind Method; Fluvoxamine; Humans; Middle Aged; Panic Disorder; Personality Inventory; Placebos; Probability; Severity of Illness Index; Treatment Outcome

The efficacy of fluvoxamine in the treatment of panic disorder complicated by depression was investigated in an 8-week, single-group, open-label, flexible-dose trial.. Seventeen patients having a principal diagnosis of panic disorder and scoring 16 or more on the 17-item Hamilton Rating Scale for Depression were treated with fluvoxamine at a mean final dose of 213 mg/ day. Outcome was assessed on measures of panic attacks, general and anticipatory anxiety, agoraphobic avoidance, depression, disability, and fear of anxiety symptoms.. Subjects improved on all measures except agoraphobic avoidance. Thirteen either chose to remain on fluvoxamine treatment after the study ended or resumed taking it after a brief period without medication or on another medication.. Fluvoxamine appears to be effective in this population.

Topics: Adult; Agoraphobia; Depressive Disorder; Drug Administration Schedule; Family Practice; Female; Fluvoxamine; Humans; Male; Middle Aged; Panic Disorder; Psychiatric Status Rating Scales; Treatment Outcome

This study compared the efficacy, tolerability, and safety of fluvoxamine, imipramine, and placebo in the treatment of panic disorder with or without agoraphobia. Fifty-four outpatients participated in the randomized, double-blind trial as part of a multicenter trial. After meeting inclusion criteria and completing screening requirements (e.g., laboratory testing, electrocardiogram, physical examination), patients were entered in a single-blind placebo washout phase. They were then randomized to either fluvoxamine, imipramine, or placebo. Measurements completed at each visit included the number and severity of panic attacks per week, the Sheehan Panic and Anticipatory Anxiety Scale, and the Clinical Global Impressions, and others. Results show that fluvoxamine is more effective than placebo and as effective as imipramine in reducing spontaneous panic attacks in moderate to severe panic disorder. However, starting doses of fluvoxamine and imipramine should be low to minimize untoward side effects (such as insomnia and agitation) and maintain compliance.

Topics: Adult; Agoraphobia; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fluvoxamine; Humans; Imipramine; Male; Panic Disorder; Psychiatric Status Rating Scales; Time Factors

Factors that predict nonresponse to drug therapy (brofaromine or fluvoxamine) were investigated in a sample of 44 panic disorder patients. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment. Using this definition, 15 patients (32.6%) were considered nonresponders. Nonresponders had a higher score on the Blood-Injury subscore of the Fear Questionnaire (FQ) and more often had high scores on several FQ subscores, indicative of comorbid phobic symptoms. These variables were subsequently used to predict nonresponse.

Topics: Adult; Agoraphobia; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Monoamine Oxidase Inhibitors; Panic; Panic Disorder; Personality Inventory; Phobic Disorders; Piperidines; Prognosis; Treatment Outcome

The purpose of this comparative outcome study was to investigate whether the effects of exposure in vivo treatment for panic disorder with agoraphobia could be enhanced by adding interventions specifically for panic attacks before the start of exposure treatment. The additional effect of two types of treatment for panic attacks--pharmacological (fluvoxamine) and psychological (repeated hyperventilation provocations and respiratory training)--was examined. Thus, the combined treatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone.. Ninety-six patients were randomly assigned to four treatment conditions: double-blind, placebo-controlled fluvoxamine followed by exposure in vivo, psychological panic management followed by exposure, and exposure in vivo alone. Outcome was assessed by self-report measures, a standardized multitask behavioral avoidance test, and continuous monitoring of panic attacks. Seventy-six patients completed the study.. All four treatments were effective and resulted in a significant decrease of agoraphobic avoidance. Moreover, the combination of fluvoxamine and exposure in vivo demonstrated efficacy superior to that of the other treatments and had twice as large an effect size (difference between pre- and posttreatment scores) on self-reported agoraphobic avoidance. The other treatments did not differ among each other in effectiveness.. Results of the study indicate that the short-term outcome of exposure in vivo treatment can be enhanced by adding fluvoxamine treatment. Psychological panic management combined with exposure was not superior to exposure alone of equal duration.

Topics: Adolescent; Adult; Aged; Agoraphobia; Ambulatory Care; Behavior Therapy; Breathing Exercises; Combined Modality Therapy; Female; Fluvoxamine; Humans; Hyperventilation; Male; Middle Aged; Panic Disorder; Patient Dropouts; Personality Inventory; Placebos; Treatment Outcome

Several reports suggest that selective serotonin reuptake blockers are helpful in the treatment of panic disorder. The aim of the study was to compare fluvoxamine with placebo in 50 panic disorder patients by using an 8-week, double-blind, parallel-groups design. Weekly assessment included a panic attack diary (frequency and severity), the Montgomery-Asberg Depression Scale, the Clinical Anxiety Scale, and the Sheehan Disability Scale. Although both groups improved on all measures, the fluvoxamine group experienced significantly less frequent major panic attacks from the third week on and significantly lower ratings on anxiety, depression, and disability from the sixth week on. Mean ratings of the severity of major and the severity and frequency of minor attacks were not affected differently by fluvoxamine and placebo. At the end of the study, significantly more patients on fluvoxamine were free of major and minor panic attacks. The results indicate that: (1) the administration of fluvoxamine, as compared with placebo, led to a significant reduction in the number of panic attacks. (2) The severity of panic attacks was not affected by fluvoxamine. (3) The effect of fluvoxamine on anxiety, depressive mood, and disability differed from placebo only after 6 weeks of treatment, after which the placebo group showed either no further improvement or a reversal of symptoms. (4) Participation in a drug study, even without additional psychotherapy, led to significant improvement in all patients.

Topics: Adult; Agoraphobia; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Panic Disorder; Personality Assessment; Single-Blind Method

Clinical and preclinical data suggest a link between serotonin [5-hydroxytryptamine (5-HT)] function and certain psychopathologic dimensions of anxiety disorders. Antidepressants consistently have been found to exert a favorable effect in anxiety disorders, particularly panic disorders. Clinical studies with 5-HT-selective drugs have shown that 5-HT neurons may comprise the site at which anxiolytic drugs exert a significant proportion of their action. Thus, fluvoxamine, a selective 5-HT uptake inhibitor, but not maprotiline, a selective noradrenaline uptake inhibitor, was found to be efficacious in panic disorder. The clinical effect of fluvoxamine revealed a noteworthy time course. After an initial increase in anxiety, improvement was attained gradually. On the basis of this finding, we tentatively hypothesized that stimulation of the 5-HT receptors, resulting from uptake inhibition, would worsen the condition of the patient, while down-regulation of the 5-HT receptors, resulting from chronic treatment, would account for the clinical efficacy. Thus, we performed a study in which ritanserin, a putative 5-HT2 antagonist, was compared with fluvoxamine. Ritanserin was found to be ineffective in the treatment of panic disorder symptoms, suggesting that 5-HT2 receptors may not be critically involved in the mechanism underlying the anxiolytic activity of 5-HT uptake inhibitors. It would seem, therefore, that other 5-HT-receptor subtypes, e.g., 5-HT1, may be implicated in this effect. Recent studies with selective 5-HT1 agonists support this hypothesis.

Topics: Adolescent; Adult; Aged; Agoraphobia; Brain; Clinical Trials as Topic; Fear; Female; Fluvoxamine; Humans; Male; Middle Aged; Oximes; Panic; Phobic Disorders; Piperidines; Psychological Tests; Random Allocation; Receptors, Serotonin; Ritanserin

A double-blind comparative study with fluvoxamine, a specific serotonin uptake inhibitor, and maprotiline, a specific noradrenaline uptake inhibitor, was conducted in 44 patients suffering from panic disorder with or without phobic avoidance. Patients were treated with 150 mg of either fluvoxamine or maprotiline daily for 6 weeks. Fluvoxamine was found to be a potent anti-panic agent. The number of panic attacks decreased significantly during treatment. The level of anxiety showed a noteworthy time course. After an initial increase during the first week of treatment, the level of anxiety declined significantly as compared to baseline on continuation of the treatment. The therapeutic properties of fluvoxamine were therefore apparent from week 4 on. In addition, the associated depressive symptomatology decreased as well. Relative to fluvoxamine, maprotiline was ineffective in the treatment of panic disorders. Maprotiline had a slight effect on the depressive symptoms but virtually no effect on the level of anxiety. These findings support the hypothesis that serotonergic pathways in the brain are implicated in the pathogenesis of panic disorders. The data are at variance, however, with findings indicating that drugs that are efficacious in panic disorder act by altering noradrenergic function.

Topics: Adult; Agoraphobia; Anthracenes; Anxiety Disorders; Brain; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Fear; Female; Fluvoxamine; Humans; Male; Maprotiline; Oximes; Panic; Phobic Disorders; Psychological Tests; Receptors, Adrenergic; Receptors, Serotonin; Serotonin Antagonists

A double-blind comparative study of clomipramine and fluvoxamine was performed in 50 patients suffering from anxiety disorders (DSM-III). Patients were treated for 6 weeks with either 150 mg of clomipramine or 100 mg of fluvoxamine. The results show that both drugs at the dosages used are equipotent in reducing anxiety symptoms as assessed with the Hamilton Anxiety Scale and the Spielberger State-Trait Anxiety Inventory. Clomipramine differed from fluvoxamine in its efficacy with respect to associated depressive symptomatology in that it had a more pronounced effect on the Self Rating Depression Scale. The results support the hypothesis that brain serotonergic pathways are implicated in the pathophysiology of anxiety disorders, particularly in agoraphobia and panic disorders.

Topics: Adult; Agoraphobia; Anxiety Disorders; Clinical Trials as Topic; Clomipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Panic; Psychological Tests; Serotonin Antagonists

To determine whether panic disorder is associated with elevated serum cholesterol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxiety disorder and phobias. To date, there are only 2 reports on cholesterol levels of obsessive-compulsive disorder (OCD) patients, giving controversial results.. We compared serum cholesterol levels of anxiety disorder patients, OCD patients, and normal control subjects with each other (n = 60 in each group). Serum cholesterol was measured in each subject before treatment. Subjects of the 3 groups were matched by age and sex.. Patients with anxiety disorders and OCD had elevated cholesterol levels, compared with normal control subjects. Cholesterol levels in OCD patients were comparable with those in patients with phobia.. Our data support the assumption that elevation in cholesterol level is not a specific feature of panic disorder (as most assumed), but more generally associated with anxiety disorders. Increased cholesterol levels in patients with anxiety disorders and OCD may be of clinical relevance.

Topics: Adult; Agoraphobia; Anxiety Disorders; Cholesterol; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors

The authors investigated whether 6 weeks of treatment with fluvoxamine would decrease the anxiogenic response to the 35% CO2 challenge in 11 patients with DSM-III-R panic disorder with agoraphobia.. The patients underwent a 35% CO2 challenge at baseline and again after 6 weeks of fluvoxamine treatment.. The anxiogenic effect of CO2 was significantly (p < .05) reduced during fluvoxamine treatment.. The results suggest a relationship between the anxiogenic effect of CO2 and the therapeutic effect of fluvoxamine.

Topics: Adult; Agoraphobia; Ambulatory Care; Carbon Dioxide; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Panic Disorder; Psychiatric Status Rating Scales; Serotonin; Severity of Illness Index; Treatment Outcome

The authors describe three patients whose panic disorder began during recreational use of MDMA (Ecstasy) and was subsequently complicated by agoraphobic avoidance that continued autonomously after cessation of the drug. Their panic disorder responded well to serotoninergic antidepressant drugs. Theoretical and practical implications are discussed.

Topics: 3,4-Methylenedioxyamphetamine; Adult; Agoraphobia; Alcohol Drinking; Amitriptyline; Arousal; Fluvoxamine; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Panic Disorder; Recurrence; Substance Withdrawal Syndrome; Tranylcypromine

Thirty-seven patients presented with paroxysmal neurological manifestations attributed to anxiety attacks. The manifestations included loss of consciousness, focal sensorimotor deficits, diffuse dysesthaesiae, visual disorders and tremor. They lasted 10 to 45 minutes and occurred once per day to once per week. Organic pathology was dismissed on the basis of normal examinations and atypical course. In all patients questioning revealed symptoms that were those of acute anxiety. The fact that these attacks took place in suggestive (circumstances e.g. in crowds and car driving), and that they could be induced by challenge tests hyperpnoea, infusion of lactate) suggested that these disorders were consecutive to panic attacks.

Topics: Adult; Agoraphobia; Anti-Anxiety Agents; Benzodiazepines; Female; Fluvoxamine; Humans; Male; Middle Aged; Nervous System Diseases; Panic Disorder; Recurrence; Tremor; Vertigo

Apathy, indifference, loss of initiative, or disinhibition (without concurrent sedation or hypomania) were observed among five patients receiving the serotonin reuptake blocking antidepressants fluvoxamine or fluoxetine. These effects appeared to be dose related. They disappeared rapidly when the dose of fluvoxamine, which has a short half-life, was reduced. Fluoxetine, which has a long half-life, was more difficult to titrate. A possible relationship between mild drug-induced indifference and the therapeutic effects of serotonin reuptake blocking medication in anxiety disorders is discussed.

Topics: Adult; Agoraphobia; Antidepressive Agents; Anxiety Disorders; Arousal; Depressive Disorder; Dose-Response Relationship, Drug; Fatigue; Female; Fluoxetine; Fluvoxamine; Humans; Impulsive Behavior; Male; Middle Aged; Motivation; Oximes; Panic; Serotonin Antagonists