fluvoxamine and Anxiety-Disorders

The purpose of this study was to conduct a systematic review of the pharmacological options available to treat patients diagnosed with attention-deficit hyperactivity disorder and anxiety disorder, for generating evidence on the safest, most-effective and tolerable pharmacotherapy. To this end, a systematic search was performed in three electronic databases (Medline, Scopus and Directory of Open Access Journals; December 2017). Randomized, double-blind, parallel-design clinical trials evaluating the efficacy, safety or tolerability of therapies for attention-deficit hyperactivity disorder and anxiety disorder in children and adolescents or adults were considered. A total of 1960 articles were retrieved from the databases, of which five studies were included in the qualitative synthesis. Two of these studies evaluated the drug atomoxetine, another study evaluated desipramine, and the remaining two studies evaluated methylphenidate, with fluvoxamine being associated with methylphenidate in one of the trials. Owing to the high heterogeneity among studies, it was not possible to combine data for meta-analyses. Although only few studies have been evaluated in this systematic review, the results point to a more significant benefit of atomoxetine. This is probably because this drug was studied in a wider age range and evaluated by more specific scales for both disorders. To further strengthen this evidence, randomized, controlled and multicenter clinical trials with larger sample sizes should be conducted.

Topics: Adolescent; Adult; Anxiety Disorders; Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Central Nervous System Agents; Child; Comorbidity; Desipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Methylphenidate; Randomized Controlled Trials as Topic; Treatment Outcome

Fluvoxamine is one of the most widely prescribed antidepressants and presents data from 30 years of clinical experience.. The present review article describes the pharmacokinetic properties of fluvoxamine and their implications for the treatment of anxiety disorders (AD). A search in the main database sources (Medline, Isi Web of Knowledge and Medscape) has been performed in order to obtain a comprehensive and balanced evaluation of fluvoxamine about the implications of its pharmacokinetic properties for the treatment of AD. The word 'fluvoxamine' has been associated with 'pharmacokinetics', 'interactions', 'generalized anxiety disorder', 'social anxiety disorder', 'social phobia', 'panic disorder', 'anxiety' and 'tolerability'. No restriction criteria were established in relation to methodology or year of publication. Only English-language articles have been selected.. Fluvoxamine presents high tolerability and safety so that it can be considered as a therapeutic option in case of panic disorder and social anxiety disorder. In contrast, its weakness is in extended interaction with CYP450 enzymatic system that may limit its use in elderly or patients with medical comorbidities. Finally, data of efficacy about generalized anxiety disorder are very limited and preliminary so that it is not possible to draw any sound conclusions.

Topics: Aged; Animals; Anti-Anxiety Agents; Anxiety Disorders; Cytochrome P-450 Enzyme System; Fluvoxamine; Humans

Some selective serotonin reuptake inhibitors (SSRIs) have recently been approved for the treatment of anxiety disorders such as obsessive-compulsive disorder, panic disorder and social anxiety disorder, and they are considered first-line treatment for anxiety disorders in Japan as well as in other countries. Previous clinical studies have suggested that the 5-HT2C receptors in subjects with anxiety disorders are hypersensitive. We recently reported that chronic treatment with fluvoxamine or paroxetine desensitized 5-HT2C receptor function. The desensitization of 5-H T2C receptor function has also been reported with other SSRIs and is considered to be a common mechanism of action of SSRIs in the treatment of anxiety disorders. In addition, some studies have suggested that 5-HT2A receptors and 5-HTIA receptors participate in anxiety disorders and the therapeutic mechanism. Both clinical studies and animal studies have indicated that the amygdala plays an essential role in anxiety and fear response. Thus, it may be important to elucidate functional changes in these 5-HT receptor subtypes in brain regions including the amygdala under the chronic administration of SSRIs to understand the anxiolytic mechanism of SSRIs.

Topics: Animals; Anxiety Disorders; Fluvoxamine; Humans; Piperazines; Receptor, Serotonin, 5-HT1A; Receptor, Serotonin, 5-HT2A; Receptor, Serotonin, 5-HT2C; Selective Serotonin Reuptake Inhibitors; Serotonin Receptor Agonists

GAD in children is characterized by excessive and uncontrollable worry about a number of events and activities in daily life. GAD is a prevalent and chronic disorder that is highly comorbid with other psychiatric disorders and has a significant affect on a child's life. Reliable and valid methods are available with which to assess childhood anxiety (eg, structured interviews and questionnaires). Furthermore, efficacious treatments for anxious children have emerged, with CBT the treatment of choice. In recent years, our understanding of childhood anxiety disorders has grown exponentially. Much of our understanding of GAD, however, is still reliant on studies of children with a range of anxiety disorders. Future research is needed that specifically examines children with GAD compared to anxious, depressed children without GAD. Such research would aid in the identification of factors unique to GAD, improve assessment methods and potentially enhance treatments for children with GAD.

Topics: Anxiety Disorders; Child; Clinical Trials as Topic; Comorbidity; Fluvoxamine; Humans; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Sertraline

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which may be used for the management of anxiety disorders in children and adolescents. Absorption of fluvoxamine was similar in adolescents to that in adults, which suggests that the maximum dosage of the drug for patients aged between 12 and 17 years can be as high as 300 mg/day. However, steady-state plasma fluvoxamine concentrations were 2 to 3 times higher in children (aged between 6 and 11 years) than in adolescents; thus, the maximum fluvoxamine dosage recommended for children is 200 mg/day. Fluvoxamine (50 to 300 mg/day) for 8 to 16 weeks significantly reduced symptoms of obsessive-compulsive disorder (OCD) [measured across multiple assessment scales] compared with placebo in a well controlled trial in paediatric patients (n = 120) or from baseline in noncomparative trials in adolescent (n = 20) or paediatric (n = 16) patients. Improvements with fluvoxamine (up to 200 mg/day) were observed for up to 1 year in 98 patients with OCD in a noncomparative trial. The drug (up to 250 or 300 mg/day) also improved symptoms of anxiety compared with placebo in an 8-week well controlled trial in 128 paediatric patients with social phobia, separation anxiety disorder or generalised anxiety disorder (GAD). Fluvoxamine (50 to 300 mg/day) appears to be well tolerated in paediatric patients, with most adverse events with the drug (except abdominal discomfort, which occurred more often in patients receiving fluvoxamine) occurring with a similar incidence to those with placebo. The most common adverse events involved the CNS or gastrointestinal system. Most adverse events reported by paediatric patients with OCD were similar to those reported by adults. In conclusion, fluvoxamine is generally well tolerated and has demonstrated short-term efficacy compared with placebo in the treatment of OCD, and social phobia, separation anxiety disorder or GAD in well controlled trials in paediatric patients. Reductions in symptoms of anxiety with fluvoxamine have been observed for up to 1 year in children and adolescents with OCD. However, there are currently no comparative trials of fluvoxamine with other pharmacological agents. In the absence of such trials, current consensus opinion recommends that when pharmacotherapy is indicated, fluvoxamine, like other SSRIs, can be used as first-line treatment for anxiety disorders, particularly OCD, in paediatric patients. However, direct comparisons are required to assess the

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Child; Fluvoxamine; Humans

The disposition characteristics and pharmacokinetic parameters of drugs provide fundamental data for designing safe and effective dosage regimens. A drug's volume of distribution, clearance, and the derived parameter, half-life, are particularly important, as they determine the degree of fluctuation between a maximum and minimum plasma concentration during a dosage interval, the magnitude of the steady-state concentration, and the time to reach a steady-state plasma concentration upon chronic dosing. Potential drug-drug interactions can be predicted with knowledge of affinities for various cytochrome P450 (CYP) isozymes.. The literature was searched for information related to the pharmacokinetic properties of fluvoxamine and reports of its involvement in drug interactions.. The primary pharmacokinetic variables for fluvoxamine have been estimated in single and multiple dose studies in animals, health volunteers, and patients. Fluvoxamine is well absorbed after oral administration, widely distributed in the body, and eliminated with a mean half-life of 15 hours and a range from 9 hours to 28 hours. Its disposition is altered in hepatic, but not renal, disease. Data from elderly subjects reflect a modest need for dosage adjustment in this population. Fluvoxamine produces no active metabolites. The specific cytochrome isozymes involved in the hepatic elimination of the drug are undefined. Data from studies relating the plasma concentration of fluvoxamine to its clinical effects do not support routine plasma concentration monitoring in depression or anxiety disorders. Fluvoxamine has prominent affinity for the CYP12 isozyme, lesser affinity for the CYP3A4 and CYP2C isozymes, and minimal affinity for CYP2D6. This profile suggests the need for careful dosage adjustment when used together with some drugs that have a narrow therapeutic range in order to minimize inhibiting their metabolism.. Overall, the pharmacokinetic profile of fluvoxamine is adequately defined to provide guidelines for developing safe and effective dosage regimens for most types of patients.

Topics: Adolescent; Adult; Age Factors; Aged; Animals; Anxiety Disorders; Biological Availability; Cytochrome P-450 Enzyme System; Depressive Disorder; Drug Administration Schedule; Drug Interactions; Drug Monitoring; Female; Fluvoxamine; Half-Life; Humans; Intestinal Absorption; Male; Middle Aged; Protein Binding; Sex Factors; Tissue Distribution

To review the respective pharmacologic profiles of the selective serotonin reuptake inhibitors (SSRIs), with particular emphasis placed on clinically relevant distinctions.. A MEDLINE search was conducted to identify English language literature published within the last five years on the four SSRIs (fluoxetine, sertraline, paroxetine, fluvoxamine). Previous review articles were scrutinized for additional citations, and manufacturers provided a contemporary bibliography of more recent material.. Studies were selected for specific citation on the basis of comparative research merit and the contribution of this original literature to the pharmacologic profile(s) described.. All SSRIs appear to be more efficacious than placebo for the acute treatment of major depressive disorder (MDD). Short-term (six-week) efficacy was comparable with that of tricyclic antidepressants for the amelioration of MDD regarded as moderate in severity. Further comparative trials are clearly indicated to demonstrate the therapeutic benefits of SSRIs in specific populations (e.g., geriatric, severely ill) and to demonstrate sustained benefit with long-term prophylaxis. Other potential indications for SSRIs include obsessive-compulsive disorder, panic disorder, bulimia, and chronic pain syndromes. Pharmacokinetic profiles of the four SSRIs reveal similar parametric values, and most quantitative differences are of limited clinical significance. Adverse effects are common but ordinarily mild and transient, primarily restricted to the gastrointestinal tract and central nervous system. Important differences in the prevalence or severity of these adverse effects await the accumulation of further clinical experience and the completion of additional comparative trials. Similarly, the relative propensity of SSRIs to inhibit the metabolism of other medications is currently under investigation.. The four SSRIs studied appear to be more similar than they are different. Slowly, important distinctions are beginning to emerge with regard to adverse effect profiles and potential drug interactions. Given that the costs of these respective medications are comparable, such differences may ultimately serve to establish the preferential selection of individual agents in specific clinical situations.

Topics: 1-Naphthylamine; Alcoholism; Antidepressive Agents; Anxiety Disorders; Clinical Trials as Topic; Depressive Disorder; Drug Interactions; Fluoxetine; Fluvoxamine; Humans; Paroxetine; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Adult; Ambulatory Care; Anxiety Disorders; Bulimia; Depression; Drug Utilization Review; Fluvoxamine; Hospitalization; Humans; Mental Disorders; Outcome and Process Assessment, Health Care

5HT has been implicated in mechanisms of anxiety and depression for many years but the evidence is contradictory. Perhaps one error has been to think of 5HT as a unitary system when in reality it is highly differentiated. There has been an explosive increase in knowledge about different 5HT receptor subtypes and it has long been known that there are different anatomical subsystems. Evidence will be summarised that the different systems subserve different psychological functions and that dysfunction in the different systems results in depression, anxiety, panic and OCD in an understandable way. Much evidence is compatible with the idea that 5HT systems reduce the impact of impending or actual aversive events. Anticipation of an aversive event is associated with anxiety and this motivates avoidance behaviour--a normal adaptive response. There is evidence that this is mediated by projections of the dorsal raphe nucleus and associated 5HT2 and 5HT3 receptors. Projections of the median raphe nucleus and associated 5HT1A receptors appear to mediate resilience to aversive events once they have occurred or if they persist. When this system breaks down depression results. It will be argued that all effective antidepressants act on 5HT1A, natural mechanisms of resilience.

Topics: Anxiety Disorders; Brain; Depressive Disorder; Fluvoxamine; Humans; Life Change Events; Receptors, Serotonin; Serotonin

Alcoholism is a multifaceted medicosocial problem. Recent literature discusses a common dyad, alcoholism and anxiety. Both disorders are interdigitated with the brain amine serotonin (5-hydroxytryptamine, 5-HT). Direct 5-HT activation reportedly attenuates alcohol consumption, whereas depletion enhances use patterns. Acute alcohol consumption has also been associated with a transient rise, albeit eventual diminished 5-HT turnover. A variety of 5-HT models have confirmed this observation, e.g., reduced platelet 5-HT content, uptake, and cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid. Such altered characteristics of 5-HT secondary to chronic alcohol use may explain the frequent morbidity of anxiety and/or depression. Acute alcohol consumption is also associated with accumulation of the 5-HT aldehyde derivative 5-hydroxymethtryptoline. Thus, alcohol may induce the in vivo formation of aldehydes, e.g., beta-carbolines, that themselves possess high lipophilicity and psychotropic activity. Future investigation into 5-HT-specific pharmacologic probes in alcoholism will be interesting. Preliminary research has consistently demonstrated that 5-HT-enhancing agents (e.g., zimelidine or fluvoxamine) decrease alcohol consumption, preference, and short-term memory decrements. Thus, 5-HT appears to represent at least one common denominator for a spectrum of behavioral disorders including anxiety and alcoholism.

Topics: Alcohol Drinking; Alcoholism; Animals; Anti-Anxiety Agents; Anxiety Disorders; Arousal; Brain; Fluvoxamine; Humans; Oximes; Receptors, Serotonin; Serotonin; Zimeldine

Diagnosis of cancer causes psychological distress. The present study investigated the safety and efficacy of fluvoxamine therapy in gynecologic cancer patients with either adjustment disorder or major depression after cancer was diagnosed.. Screening with the Hospital Anxiety and Depression Scale (HADS) was conducted at least 2 weeks after notification of the diagnosis of cancer in 214 gynecologic cancer patients hospitalized between January 2007 and December 2008. The HADS cutoff score was set at 11 points or greater. Informed consent to the study was obtained from 10 patients, and fluvoxamine was administered for 8 weeks. As primary end points, the safety and efficacy of fluvoxamine were evaluated using the HADS and the SF-36. As a secondary end point, the Clinical Global Impression was determined.. The total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 4, and 6 weeks of treatment, respectively. The SF-36 revealed significant improvement in vitality, mental health, and role (emotional) after 8 weeks of treatment. In the 5 patients with adjustment disorder, only the HADS anxiety score was significantly reduced after 4 weeks. In the 5 patients with major depression, the total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 8, and 6 weeks, respectively. According to the SF-36, the adjustment-disorder groups showed significant improvement in mental health after 8 weeks of treatment, whereas the major-depression group showed significant improvement in vitality and role (emotional) after 8 weeks. No adverse events occurred in any subject. Assessment of the Clinical Global Impression suggested that fluvoxamine improved psychological distress in all 10 subjects.. The present findings suggest that fluvoxamine is useful for alleviating psychological distress, including adjustment disorder and major depression, in gynecologic cancer patients. Management of psychological distress after diagnosis of cancer is important.

Topics: Adult; Aged; Anti-Anxiety Agents; Anxiety Disorders; Combined Modality Therapy; Female; Fluvoxamine; Genital Neoplasms, Female; Humans; Middle Aged; Psychometrics; Quality of Life; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

It is widely accepted that selective serotonin reuptake inhibitors (SSRIs) require 2 to 4 weeks of administration before improvements in emotional symptoms of depression are seen. We evaluated whether early monitoring of Hamilton Rating Scale for Depression (HAMD) scores in patients treated with the SSRI fluvoxamine could predict antidepressant response, and also assessed the relationship between the onset of clinical response following the start of fluvoxamine administration and its plasma concentration. Twelve depressed patients (baseline HAMD score ≥15) received an initial dose of fluvoxamine (50 mg/d) followed by an optimized maintenance dose according to their clinical symptoms after 7 d. HAMD scores and plasma drug concentrations were determined at 7 and 28 d after the first administration. There were 7 responders and 5 non-responders on day 28, as evaluated by HAMD scores. The HAMD score for the responders was significantly lower than that for the non-responders on day 7 (mean±S.D., 11.6±6.1 vs. 26.6±6.5, p=0.006). Thus, the reduction in HAMD score on day 7 was clearly divided between responders and non-responders. On day 28, the plasma concentration of fluvoxamine in responders was lower than that in non-responders (14.2±10.5 ng/ml vs. 44.2±28.1 ng/ml, p=0.051). Furthermore, receiver operating characteristic curve analysis conducted on day 28 revealed an upper concentration threshold of 28.2 ng/ml (p=0.042), with none in the responder group above that level. Our results suggest that HAMD score after the first week of treatment with fluvoxamine and the upper threshold of plasma drug concentration could predict whether a patient is a non-responder.

Topics: Adult; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Feeding and Eating Disorders; Female; Fluvoxamine; Humans; Japan; Male; Middle Aged; Mood Disorders; ROC Curve; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The aim of this study was to examine the prevalence of activation cluster adverse events (AC-AEs) in youths treated with the selective serotonin reuptake inhibitor (SSRI) fluvoxamine for anxiety and the relationship of AC-AEs to SSRI blood levels.. Data from the Research Units on Pediatric Psychopharmacology (RUPP) Anxiety Study were examined for 45 youths (22 active fluvoxamine, 23 placebo) treated for Diagnostic and Statistical Manual for Mental Disorders, 4(th) edition (DSM-IV) anxiety disorders at the Johns Hopkins University site with an 8-week forced-flexible titration schedule. As part of the double-blind placebo-controlled trial, AC-AEs were recorded by clinicians at weekly patient visits. AC-AEs were defined as hyperactivity, activation, and disinhibition. Demographic characteristics, daily doses, and week-8 blood levels were examined in relation to the presence of AC-AEs. The prevalence of AC-AE and time to first event were established for those who experienced this side effect.. AC-AEs were found in 10 of 22 participants (45%) receiving fluvoxamine and only 1 of 23 in the placebo group (4%). The onset of AC-AEs occurred from week 1 to week 8, with the majority occurring at or before week 4. The mean fluvoxamine blood level at week 8 in subjects with AC-AEs was higher than in subjects without AC-AEs (n = 16, t = -2.61, p = 0.04). Neither the age of the participants nor family history of bipolar or anxiety disorder differed between those who did and did not develop an AC-AE.. AC-AEs were common side effects of fluvoxamine, often appeared during the first 8 weeks of treatment, and were associated with higher fluvoxamine blood levels. Close monitoring for AC-AEs, not only when initiating SSRI treatment but also throughout dose titration, is recommended for early identification of activation.

Topics: Adolescent; Anxiety Disorders; Child; Child Behavior Disorders; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Selective Serotonin Reuptake Inhibitors

The present study examined sleep-related problems (SRPs) among a large sample (n = 128) of youth with anxiety disorders (i.e., generalized, separation, and social). The frequency of eight specific SRPs was examined in relation to age, gender, type of anxiety disorder, anxiety severity, and functional impairment. The impact of pharmacological treatment (fluvoxamine versus pill placebo) in reducing SRPs also was examined.. As part of a large, double-blind, randomized, controlled trial (Research Units on Pediatric Psychopharmacology Anxiety Study Group), clinician and parent reports of SRPs were examined among children and adolescents, ages 6 to 17 years, before and after treatment.. Eighty-eight percent of youth experienced at least one SRP, and a majority (55%) experienced three or more. Total SRPs were positively associated with anxiety severity and interference in family functioning. Significantly greater reductions in SRPs were found among children treated with fluvoxamine compared with placebo.. These findings indicate that SRPs are commonly associated with childhood anxiety disorders and suggest a need for the assessment of and attention to these problems in research and clinical settings.

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Anxiety, Separation; Child; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Phobic Disorders; Sleep Wake Disorders

The objective of this study was to examine the effectiveness of a meditation-based stress management program in patients with anxiety disorder.. Patients with anxiety disorder were randomly assigned to an 8-week clinical trial of either a meditation-based stress management program or an anxiety disorder education program. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Symptom Checklist--90-Revised (SCL-90-R) were used to measure outcome at 0, 2, 4, and 8 weeks of the program.. Compared to the education group, the meditation-based stress management group showed significant improvement in scores on all anxiety scales (HAM-A, P=.00; STAI state, P=.00; STAI trait, P=.00; anxiety subscale of SCL-90-R, P=.00) and in the SCL-90-R hostility subscale (P=.01). Findings on depression measures were inconsistent, with no significant improvement shown by subjects in the meditation-based stress management group compared to those in the education group. The meditation-based stress management group did not show significant improvement in somatization, obsessive-compulsive symptoms, and interpersonal sensitivity scores, or in the SCL-90-R phobic anxiety subscale compared to the education group.. A meditation-based stress management program can be effective in relieving anxiety symptoms in patients with anxiety disorder. However, well-designed, randomized, and controlled trials are needed to scientifically prove the worth of this intervention prior to treatment.

Topics: Alprazolam; Anti-Anxiety Agents; Anxiety Disorders; Combined Modality Therapy; Fluvoxamine; Humans; Meditation; Paroxetine; Program Development; Self Care; Sertraline; Stress, Psychological; Surveys and Questionnaires

To evaluate the prevalence of somatic symptoms (SSs) in children and adolescents with anxiety disorders; the relationship between SSs and anxiety severity, impairment, and child global functioning; and the impact of fluvoxamine (FLV) versus pill placebo (PBO) on reducing SSs.. As part of a double-blind, placebo-controlled trial, 128 children (mean age, 10.8 years; range, 6-17) with DSM-IV anxiety disorders (i.e., social, separation, and generalized anxiety) were assessed by expert clinicians on 16 SSs using the Pediatric Anxiety Rating Scale.. The most common SSs at baseline were restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%). Older children (age 12 and older) reported more SSs than younger children, boys and girls reported similar numbers of SSs, and SSs were higher among children with than without generalized anxiety disorder. SSs were significantly and positively correlated with anxiety severity, impairment, and global functioning. Pre-/postreductions in SSs were statistically significant in both PBO and FLV conditions; however, FLV was superior to PBO in reducing SSs.. SSs are highly prevalent among children and adolescents with anxiety disorders and are associated with greater anxiety severity and impairment. Treatment with FLV was effective in reducing rather than increasing SSs. The high rates of SSs in youths with each of the three anxiety disorders suggest a re-evaluation of SSs in the DSM-IV diagnostic criteria for the most common anxiety disorders among children and adolescents.

Topics: Adolescent; Anxiety Disorders; Child; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Somatoform Disorders

Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children.. Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions-Improvement scores were also obtained.. Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global Impressions-Improvement-defined responder rate. Medications in both arms were well tolerated.. Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

Topics: Adolescent; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Comorbidity; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Methylphenidate; Selective Serotonin Reuptake Inhibitors

To evaluate the safety, tolerability, and benefit of fluvoxamine for the treatment of major depressive disorder or anxiety disorders in children and adolescents with cancer.. The study was conducted from 2001 to 2004 at a pediatric hematology-oncology center. Fifteen children and adolescents with cancer were treated with fluvoxamine 100 mg/day in an open prospective 8-week trial. Safety and tolerability were evaluated at baseline and at weeks 4 and 8 by blood tests and the Side Effects Checklist. Clinical benefit was assessed with the Clinical Global Impressions-Improvement, the Children's Depression Rating Scale-Revised, and the Pediatric Anxiety Rating Scale.. Fluvoxamine was well tolerated by all subjects. Psychiatric symptoms improved significantly.. In this open trial, fluvoxamine appeared to be well tolerated and was associated with a promising reduction in the depression and anxiety symptoms of pediatric patients with cancer.

Topics: Adolescent; Anti-Anxiety Agents; Antidepressive Agents, Second-Generation; Anxiety Disorders; Child; Depressive Disorder, Major; Fluvoxamine; Follow-Up Studies; Humans; Neoplasms; Pilot Projects; Selective Serotonin Reuptake Inhibitors; Sick Role

This was a randomized double-blind placebo-controlled multicenter study to assess the efficacy, safety, and tolerability of fluvoxamine in a controlled release (CR) formulation for treatment of generalized social anxiety disorder (GSAD). A total of 300 subjects with GSAD were randomly assigned to receive either fluvoxamine CR (N = 149) or placebo (N = 151) for 12 weeks. Mean changes from baseline to end point in Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression Severity of Illness Scale (CGI-S), Sheehan Disability Scale (SDS), as well as the mean end point scores in Clinical Global Impression Improvement Scale (CGI-I) and Patient Global Impression of Improvement Scale (PGI) were compared between the fluvoxamine CR and placebo treatment groups. Arizona Sexual Experience Scale (ASEX), adverse event, and other safety parameters were also assessed. The results demonstrated that fluvoxamine CR was significantly superior to placebo in decreasing LSAS total score (primary measure) starting at week 4. At end point, there was a mean change from baseline of -36.1 +/- 2.7 (37% reduction) in the LSAS total score in the fluvoxamine CR group compared with -27.3 +/- 2.4 (28% reduction) in the placebo group (P = 0.020 for mean change). Fluvoxamine CR was also significantly superior to placebo in SDS, CGI-S, CGI-I at end point (secondary measures). When compared with placebo, fluvoxamine CR did not cause any significant weight gain or clinically significant sexual dysfunction as measured by ASEX. In summary, fluvoxamine CR is an efficacious, safe, and well-tolerated treatment of generalized social anxiety disorder.

Topics: Adolescent; Adult; Aged; Anxiety Disorders; Delayed-Action Preparations; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors

To examine whether age, gender, ethnicity, type of anxiety disorder, severity of illness, comorbidity, intellectual level, family income, or parental education may function as moderators and whether treatment adherence, medication dose, adverse events, or blinded rater's guess of treatment assignment may function as mediators of pharmacological treatment effect in children and adolescents with anxiety disorders.. The database of a recently reported double-blind placebo-controlled trial of fluvoxamine in 128 youths was analyzed. With a mixed-model random-effects regression analysis of the Pediatric Anxiety Rating Scale total score, moderators and mediators were searched by testing for a three-way interaction (strata by treatment by time). A two-way interaction (strata by time) identified predictors of treatment outcome.. No significant moderators of efficacy were identified, except for lower baseline depression scores, based on parent's (but not child's) report, being associated with greater improvement (p < .001). Patients with social phobia (p < .05) and greater severity of illness (p < .001) were less likely to improve, independently of treatment assignment. Blinded rater's guess of treatment assignment acted as a possible mediator (p < .001), but improvement was attributed to fluvoxamine, regardless of actual treatment assignment. Treatment adherence tended to be associated (p = .05) with improvement.. In this exploratory study, patient demographics, illness characteristics, family income, and parental education did not function as moderators of treatment effect. Social phobia and severity of illness predicted less favorable outcome. Attribution analyses indicated that study blindness remained intact. The presence of concomitant depressive symptoms deserves attention in future treatment studies of anxious children.

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Child; Epidemiologic Factors; Female; Fluvoxamine; Humans; Male; Randomized Controlled Trials as Topic; Regression Analysis; Treatment Outcome

An 8-week placebo-controlled study, the Research Units on Pediatric Psychopharmacology Anxiety Study, documented beneficial effects of fluvoxamine in the treatment of pediatric social anxiety, separation anxiety, or generalized anxiety disorders. Following completion of this study, participants were invited to enter a 6-month open-label treatment phase designed to examine three issues: (a) long-term maintenance of response in fluvoxamine responders, (b) acute response to fluoxetine in fluvoxamine nonresponders, and (c) acute response to fluvoxamine in placebo nonresponders.. Participants aged 6-17 years meeting criteria for social anxiety, separation anxiety, or generalized anxiety disorders previously treated in an 8-week placebo-controlled trial (n = 128) were offered open treatment. Changes in symptoms of anxiety during open treatment were assessed in three groups: (a) fluvoxamine responders maintained on fluvoxamine, (b) fluvoxamine nonresponders changed to fluoxetine, and (c) placebo nonresponders changed to fluvoxamine. Response was defined based on Clinical Global Impression criteria.. During 6 months of continued open treatment, anxiety symptoms remained low in 33 of 35 (94%) subjects who initially responded to fluvoxamine. Among 14 fluvoxamine nonresponders switched to fluoxetine, anxiety symptoms appeared significantly improved in 10 (71%) subjects. Finally, among 48 placebo nonresponders, 27 (56%) showed clinically significant improvement in anxiety on fluvoxamine.. The current findings concerning extended treatment of pediatric anxiety disorders are only preliminary, because treatment was uncontrolled. Results suggest that an initial fluvoxamine response is likely to be retained with continued treatment, that some fluvoxamine nonresponders may respond to fluoxetine, and that some placebo nonresponders may respond to fluvoxamine.

Topics: Adolescent; Anxiety Disorders; Child; Double-Blind Method; Female; Fluoxetine; Fluvoxamine; Humans; Male; Pediatrics; Psychopharmacology; Regression Analysis

Co-morbidity of mood and anxiety disorders is often ignored in pharmacotreatment outcome studies and this complicates the interpretation of treatment response. The clinical trials are usually based on single categories from the Diagnostic and Statistical Manual of Mental Disorders (DSM).. The present study is a first attempt to differentiate the responses to antidepressants using a design that differs from that used in previous clinical trials. To avoid bias due to co-morbidity, we included patients with any DSM-III-R diagnosis of mood or anxiety disorder for which antidepressant treatment was indicated. We also explored the role of the diagnosis at the first episode in the efficacy of the different antidepressants.. A total of 92 outpatients with a mood and/or anxiety disorder were randomly assigned to treatment with imipramine or fluvoxamine in a 6-week study. The diagnosis at the first episode--or primary diagnosis--was available for 78 patients, 40 with a primary depression and 38 with a primary anxiety disorder.. Analyses using the MIXED procedure for repeated measures showed no general differences between treatment with imipramine and treatment with fluvoxamine. When the primary diagnoses were taken into consideration, differentiation occurred. Patients with primary depression showed better responses to imipramine than to fluvoxamine. The assumption that patients with primary anxiety disorder would respond better to fluvoxamine than imipramine was observed for only the Clinical Global Impression.. The results suggest that the nature of the first illness episode may be more valuable than the DSM categories of mood or anxiety disorders, which may lend support to the concept of primary versus secondary depression for purposes of differentiating treatment responses. Given the exploratory nature of the study, however, replication of our finding is needed.

Topics: Adult; Aged; Antidepressive Agents; Antidepressive Agents, Tricyclic; Anxiety Disorders; Diagnosis, Differential; Female; Fluvoxamine; Humans; Imipramine; Male; Middle Aged; Mood Disorders; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Although increasing evidence suggests that selective serotonin reuptake inhibitor (SSRI) treatment may be effective for anxiety in addition to depression, SSRI anxiolysis has not been definitively related to the inhibition of serotonin (5-HT) transport. The gene that encodes for the human serotonin transporter (5-HTT) expresses its protein in neurons and in blood platelets, and both tissues respond to transport inhibition similarly in response to SSRI treatment. This study examined the relationship between the change in the 5-HTT's apparent affinity for 5-HT and the anxiolytic response in a group of 18 fluvoxamine-treated patients meeting Structured Clinical Interview for DSM-IV criteria for both generalized anxiety disorder and major depression. Significant decreases were found in both Hamilton anxiety and Hamilton depression scores over a 2-month treatment period. Robust increases were found in the apparent affinity constant (Km) for platelet 5-HT transport with treatment, and the increases covaried significantly with the decrease in anxiety (F = 4.97, p < 0.03). The pretreatment 5-HTT Km significantly correlated with the improvement in depression scores (r = 0.53, p < 0.03), consistent with the Hypothesis of Initial Conditions. These results suggest that the therapeutic effect of SSRI treatment can be linked to the magnitude and time-course of 5-HT transport inhibition effected with fluvoxamine, a drug that seems to have an antianxiety effect of the same magnitude as its effect on depression.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Anti-Anxiety Agents; Anxiety Disorders; Carrier Proteins; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Mental Status Schedule; Middle Aged; Nerve Tissue Proteins; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins; Treatment Outcome

Drugs that selectively inhibit serotonin reuptake are effective treatments for adults with mood and anxiety disorders, but limited data are available on the safety and efficacy of serotonin-reuptake inhibitors in children with anxiety disorders.. We studied 128 children who were 6 to 17 years of age; who met the criteria for social phobia, separation anxiety disorder, or generalized anxiety disorder; and who had received psychological treatment for three weeks without improvement. The children were randomly assigned to receive fluvoxamine (at a maximum of 300 mg per day) or placebo for eight weeks and were evaluated with rating scales designed to assess the degree of anxiety and impairment.. Children in the fluvoxamine group had a mean (+/-SD) decrease of 9.7+/-6.9 points in symptoms of anxiety on the Pediatric Anxiety Rating Scale (range of possible scores, 0 to 25, with higher scores indicating greater anxiety), as compared with a decrease of 3.1+/-4.8 points among children in the placebo group (P<0.001). On the Clinical Global Impressions-Improvement scale, 48 of 63 children in the fluvoxamine group (76 percent) responded to the treatment, as indicated by a score of less than 4, as compared with 19 of 65 children in the placebo group (29 percent, P<0.001). Five children in the fluvoxamine group (8 percent) discontinued treatment because of adverse events, as compared with one child in the placebo group (2 percent).. Fluvoxamine is an effective treatment for children and adolescents with social phobia, separation anxiety disorder, or generalized anxiety disorder.

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Anxiety, Separation; Child; Female; Fluvoxamine; Humans; Male; Phobic Disorders; Psychotherapy; Selective Serotonin Reuptake Inhibitors

10 patients with anxious and 10 patients with apathic-adynamic depressions were treated with fevarin. The efficiency of the drug and its influence on the psychopathologic structure were evaluated according to some scales. It was established that therapeutic action of fevarin manifests from the 1st week of therapy in patients with anxious depressions due to its anxiolytic properties. In apathic-adynamic depressions the reduction of the symptoms was revealed by the 3-4 week of the therapy. The antidepressive effect of fevarin was retarded and didn't depend on the structure of the depression. Higher efficiency of the drug in patients with anxious depressions was explained by combination of thymoanaleptic and anxiolytic effects. The results of the study demonstrate a perspective of fevarin in therapy of anxious and apathic-adynamic depressions.

Topics: Anxiety Disorders; Depressive Disorder; Fluvoxamine; Humans; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index

Taijin kyofusho (TKS) has been categorized as a "culture-bound" illness that is unique to the East, although an alternative view holds that some TKS patients are best conceptualized as having a form of social anxiety disorder (SAD). However, pharmacotherapeutic interventions for TKS have not yet been rigorously investigated. A review was undertaken of 48 TKS patients initially treated with serotonin reuptake inhibitors (SRIs) in an outpatient setting of a Japanese hospital. Psychiatric diagnoses were determined according to DSM-IV, and a set of TKS diagnostic criteria based on a modification of DSM-IV SAD criteria. In addition, response to SRIs (clomipramine and fluvoxamine) was evaluated retrospectively using the Clinical Global Impressions (CGI) scale. All 48 patients met SAD-based TKS diagnostic criteria. In the pretreatment assessment, DSM-IV Axis I diagnoses included SAD (38%), major depressive episode (27%), and delusional disorder somatic type (15%). Sixteen (48%) of 33 patients treated with clomipramine or fluvoxamine for at least 6 months were categorized as responders (CGI = 1 or 2). Compared to responders, non-responders were significantly less likely to have pretreatment major depression, and significantly more likely to have comorbid cluster A personality disorders and to have received augmentation with antipsychotic drugs. Although TKS may be a heterogeneous condition with various comorbidities, patients invariably fulfilled diagnostic criteria for TKS based on SAD criteria. SRIs may be effective for a substantial number of TKS patients. Prospective controlled trials are necessary to confirm these findings and to delineate the pharmacotherapeutic profile of TKS.

Topics: Adolescent; Adult; Anxiety Disorders; Clomipramine; Culture; Female; Fluvoxamine; Humans; Japan; Male; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Social Behavior Disorders

Patients with panic disorder are reported to have elevated cholesterol levels. There is also some evidence that cholesterol elevation is not so much a specific condition in panic disorder but is generally associated with anxiety. So far, there is little data on cholesterol levels in patients with obsessive compulsive disorders (OCD) which is also classified as anxiety disorder.. Thirty-three patients with OCD participated in the study. Serum cholesterol was measured as pretreatment and at the end of a ten-week treatment-period. All patients received behavior therapy and, in a double-blind fashion, fluvoxamine or placebo. Severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).. Pretreatment cholesterol values of OCD patients were compared with cholesterol levels of thirty panic disorder patients and thirty normal controls. OCD patients had elevated cholesterol levels comparable with those of panic disorder patients. Cholesterol levels decreased significantly from pre- to posttreatment. OCD patients with high cholesterol levels (> or = 240 mg/dl, n = 7) could make best use of the treatment whereas patients with desirable cholesterol levels (< 200 mg/dl, n = 11) did not change their cholesterol during treatment.. Our data support the assumption that not only panic disorder but also other anxiety disorders, e.g., obsessive compulsive disorders, may be associated with serum cholesterol elevations. Effective treatment (behavior therapy and/or treatment with a selective serotonin reuptake inhibitor [SSRI]) seems to decrease cholesterol levels, especially in patients with pathological cholesterol elevations.

Topics: Adult; Anxiety Disorders; Body Mass Index; Cholesterol; Cognitive Behavioral Therapy; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Major depression with comorbid anxiety disorder is associated with poor antidepressant outcome compared with major depression without comorbid anxiety disorder. The purpose of our study was to assess changes in depressive symptoms and anxiety levels in outpatients with major depression with comorbid anxiety disorder following 12 weeks of open treatment with fluvoxamine.. We enrolled 30 outpatients (mean +/- SD age = 39.4 +/- 11.3 years; 16 women and 14 men) with DSM-IV major depressive disorder accompanied by one or more current comorbid DSM-IV anxiety disorders in our study. Patients were treated openly with fluvoxamine initiated at 50 mg/day, with an upward titration to a maximum of 200 mg/day (mean +/- SD dose = 143 +/- 45 mg/day). Efficacy assessments included the 17-item Hamilton Rating Scale for Depression (HAM-D-17) and Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales for both depression and anxiety. Intent-to-treat analysis was used to assess outcome.. The mean +/- SD number of comorbid anxiety disorders per patient was 2.1 +/- 1.1. Following fluvoxamine treatment, the mean +/- SD HAM-D-17 score dropped from 20.2 +/- 3.3 to 1 1.0 +/- 7.0 (p < .0001). The mean +/- SD depression CGI-S score dropped from 4.0 +/- 0.6 to 2.4 +/- 1.1 (p < .0001), and the mean +/- SD anxiety CGI-S score decreased from 4.1 +/- 0.8 to 2.5 +/- 1.2 (p < .0001). Eighteen (60%) of the 30 patients had CGI-I scores < or = 2 for both anxiety and depression at endpoint, with 53% showing a > or = 50% reduction in HAM-D-17 scores at endpoint.. Although preliminary, our findings suggest that fluvoxamine is effective in treating outpatients with major depression with comorbid anxiety disorder, having a significant effect on both depression and anxiety symptoms. Further double-blind, placebo-controlled trials are needed, in a larger sample, to confirm our findings.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Anxiety Disorders; Comorbidity; Depressive Disorder; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Patient Dropouts; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

The syndrome of mixed anxiety and depression (MAD) has been described and is familiar to both general psychiatrists and nonpsychiatrists. It was included in the DSM-IV appendix as a syndrome proposed for further study. Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of obsessive-compulsive disorder, was studied for its effectiveness in treating anxiety and depression simultaneously during an 8-week, open-label trial of patients with MAD. Thirteen patients were included in the final, intent-to-treat, analysis. Fluvoxamine showed moderately strong effectiveness in improving anxiety and depression with a greater effect on the depressive component. Nausea, insomnia, delayed ejaculation, and nervousness were the most common side effects reported, with no serious adverse events occurring. Future double-blind placebo-controlled studies will give more conclusive results.

Topics: Adult; Antidepressive Agents, Second-Generation; Anxiety Disorders; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Pilot Projects; Psychiatric Status Rating Scales

In an open multicentre study designed to closely reflect the clinical situation, 315 out-patients diagnosed by their psychiatrist as having depression and/or obsessive-compulsive disorder (OCD), and/or panic disorder, were treated for 12 weeks with fluvoxamine (100-300 mg/day). Twelve weeks of fluvoxamine therapy was completed by 229 (73%) patients. Longer illness duration prior to treatment was associated with a significantly reduced rate of treatment withdrawal, whereas a diagnosis of OCD was predictive of treatment withdrawal. The main reasons patients discontinued fluvoxamine therapy were adverse effects experienced before Week 8, and clinical improvement thereafter. Age, sex, and diagnosis had no predictive value for treatment outcome; however, psychiatric antecedents and duration and severity of illness at baseline were significant predictors of disease severity at endpoint. Fluvoxamine decreased both the frequency and severity of baseline symptoms, with improvement continuing for the duration of the study. Nausea was the only symptom to show an initial increase in frequency and severity, but this subsided after 4 weeks to levels below baseline frequency and severity.

Topics: Adult; Affect; Ambulatory Care; Anxiety Disorders; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Patient Compliance; Prevalence; Treatment Outcome

The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-compulsive, depressive, or anxiety symptoms. This finding suggests that addition of buspirone to ongoing fluvoxamine therapy is not an effective treatment strategy for most patients with obsessive-compulsive disorder.

Topics: Adult; Anxiety Disorders; Buspirone; Depressive Disorder; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Placebos; Psychiatric Status Rating Scales

Fluvoxamine, a selective serotonin reuptake inhibitor, was compared with lorazepam in a multicentre double-blind, parallel group study in 112 general practice patients with mixed anxiety and depression. For inclusion, patients were required to have minimum baseline scores of 21 on the Montgomery-Asberg Depression Rating Scale (MADRS) and 11 on the Clinical Anxiety Scale (CAS). Treatment was for 6 weeks. There were no significant differences between treatments at any point except in an elderly subgroup in whom anxiety improved more rapidly with lorazepam. There were significant improvements in MADRS, CAS and global ratings compared with baseline at all subsequent assessments. Improvement continued during the whole treatment period. Lorazepam produced more sedation, whilst fluvoxamine produced significantly more nausea and vomiting; this was usually early in onset and, if tolerated, resolved during the course of the study. As it is now widely recognized that benzodiazepines should only be given in short courses of 2-4 weeks, the continued improvement up to 6 weeks has implications regarding choice of treatment.

Topics: Adult; Aged; Aged, 80 and over; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Double-Blind Method; Family Practice; Female; Fluvoxamine; Humans; Lorazepam; Male; Middle Aged; Multicenter Studies as Topic; Oximes; Personality Tests; United Kingdom

To evaluate whether serotonin reuptake inhibition is critical to the treatment of obsessive-compulsive disorder, 40 outpatients with a principal diagnosis of obsessive-compulsive disorder were randomized in a double-blind fashion to 8 weeks of treatment with either the serotonin reuptake inhibitor fluvoxamine maleate (n = 21) or the norepinephrine reuptake inhibitor desipramine hydrochloride (n = 19). Fluvoxamine was significantly better than desipramine in reducing the severity of obsessive-compulsive symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale and by the global response rate ("responder" equaling "much improved"). Eleven of 21 patients were responders with fluvoxamine compared with 2 of 19 patients with desipramine. Fluvoxamine, but not desipramine, was also effective in reducing the severity of "secondary" depression. Fluvoxamine-induced improvement in symptoms of obsessive-compulsive disorder was not correlated with the severity of baseline depressive symptoms. This study provides additional evidence that the acute serotonin reuptake properties of a drug are predictive of its anti-obsessive-compulsive efficacy. It is hypothesized that the mechanism of action of serotonin reuptake inhibitors in obsessive-compulsive disorder may be related to chronic treatment-induced adaptive changes in presynaptic serotonin receptor function (eg, autoreceptor desensitization) and/or indirect influences on dopaminergic function (eg, in the basal ganglia).

Topics: Adult; Anxiety Disorders; Basal Ganglia; Depressive Disorder; Desipramine; Dopamine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Panic; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic; Receptors, Serotonin; Serotonin; Serotonin Antagonists

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

Topics: 5-Hydroxytryptophan; Anxiety Disorders; Clomipramine; Female; Fluvoxamine; Humans; Male; Oximes; Serotonin

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

Sixteen outpatients who met DSM-III criteria for obsessive-compulsive disorder completed a 20-week double-blind, crossover trial with fluvoxamine and placebo. Thirteen (81%) improved with fluvoxamine, while three (19%) improved with placebo. Fluvoxamine treatment was associated with significant improvement on measures of obsessive-compulsive symptoms, anxiety, and depression. Depressed subjects' improvement on obsessive-compulsive measures correlated with improvement in symptoms of depression. Nondepressed subjects also showed improvement on measures of obsessive-compulsive symptoms. In this trial, fluvoxamine was an effective and safe treatment for obsessive-compulsive disorder.

Topics: Adolescent; Adult; Ambulatory Care; Anxiety Disorders; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Oximes; Personality Inventory; Placebos; Psychiatric Status Rating Scales

Since the WHO declared the COVID-19 outbreak a pandemic, the most actual problem has been a change in the lifestyle of the population of Russia and the rest of the world. Fear of illness, self-isolation/quarantine, and decreased quality of life have dramatically increased the level of stress-related disorders in the population. The main mental disorders arising from stress refer to anxiety disorders (post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia, generalized anxiety disorder), obsessive-compulsive disorder, depressions of varying severity and conversion reactions. The symptoms and early warning signs of stress-related disorders may be chronic or episodic. Stress-related disorders are corrected with psychotropic therapy, which aims to restore the balance of neurotransmitters. Current first choice agents for the treatment of both pathological anxiety and depression are selective serotonin reuptake inhibitors (SSRIs). During the pandemic, the SSRI fluvoxamine is of special interest. Its mechanisms of action are recognized as potentially useful for treating COVID-19 infection. Two studies confirming the efficacy and safety of fluvoxamine in the treatment of coronavirus infection are described.. Как только Всемирная организация здравоохранения (ВОЗ) объявила вспышку COVID-19 пандемией, самой актуальной проблемой стало изменение образа жизни жителей России и всего мира. Страх перед болезнью, самоизоляция/карантин, снижение качества жизни резко повысили уровень стресс-связанных расстройств. К основным психическим нарушениям, возникающим при стрессе, относят тревожные расстройства, включая посттравматическое стрессовое расстройство, паническое расстройство, агорафобию, социальную фобию, обсессивно-компульсивное расстройство и генерализованное тревожное расстройство, депрессии различной степени выраженности, конверсионные реакции. Симптомы и ранние предупреждающие сигналы стресс-связанных расстройств по своей природе могут быть хроническими либо эпизодическими. Стресс-связанные расстройства корректируются при помощи психотропной терапии, которая направлена на восстановление баланса нейромедиаторов. К современным средствам первого выбора для лечения как патологической тревоги, так и депрессии относятся селективные ингибиторы обратного захвата серотонина (СИОЗС). В период пандемии необходимо особо отметить СИОЗС флувоксамин. Он обладает механизмами действия, которые признаются потенциально полезными для лечения инфекции COVID-19. Описываются два исследования, подтверждающие эффективность и безопасность флувоксамина в лечении коронавирусной инфекции.

Topics: Anxiety Disorders; COVID-19; Fluvoxamine; Humans; Quality of Life; SARS-CoV-2; Stress Disorders, Post-Traumatic

The current study evaluated the role of strain and compulsive trait differences in response to fluvoxamine, a common obsessive-compulsive disorder (OCD) drug, in two different mouse strains (BIG1 and BIG2) with a spontaneous compulsive-like phenotype. For compulsive-like nest-building behavior, dose-dependent attenuation of nesting by fluvoxamine was observed for the BIG1 compulsive-like strain during the first hour after administration. No significant differences were found for the BIG2 strain during the first hour, although a dose-dependent trend similar to that in the BIG1 strain was observed. Fluvoxamine dose dependently decreased the number of marbles buried in both strains 1 h after administration. For anxiety-like behaviors in the open field, no significant drug effects were found for the latency to leave the center and the number of line crossings. Significant strain differences were observed, with the BIG2 strain showing higher anxiety-like behaviors and reduced locomotor activity compared with the BIG1 strain. Consequently, this study adds predictive validity to our mouse model of OCD, whereas the anxiety-like differences between the strains add heterogeneity to our mouse model, similar to the heterogeneity observed in OCD.

Topics: Animals; Anxiety; Anxiety Disorders; Compulsive Behavior; Disease Models, Animal; Fluvoxamine; Male; Mice; Mice, Inbred Strains; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Antidepressive Agents, Second-Generation; Anxiety Disorders; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Lamotrigine; Mirtazapine; Obsessive-Compulsive Disorder; Serotonin and Noradrenaline Reuptake Inhibitors; Tic Disorders; Venlafaxine Hydrochloride

Psychiatric comorbidities are an important issue in the treatment of chronic dizziness patients.. To test the correlation between psychiatric status and subjective handicaps and to examine the effects of milnacipran on handicaps.. Hospital anxiety and depression scale (HADS) and handicaps were assessed by a questionnaire before and eight weeks after milnacipran treatment (50 mg/day) in 29 consecutive patients with chronic dizziness. Effects of milnaciplan were compared with fluvoxamine (200 mg/day).. A significant correlation was found between anxious and depressive scale scores and also between HADS and handicaps. Duration of symptoms was longer in the anxious/depressive group (HADS≧13) than in the non-anxious/depressive group. Handicaps and HADS were significantly decreased after treatment only in the anxious/depressive group. There were no overall differences in drug effects between milnaciplan and fluvoxamine. However, the rate of patients with a post/pre ratio of handicaps <80% was higher in milnaciplan group compared with the fluvoxamine group.. Not only anxiety disorders but also depression should be considered as comorbid psychiatric disorders in patients with chronic dizziness. Dizzy patients with psychiatric comorbidities have a longer duration of symptoms and more handicaps than those without psychiatric disorders. Milnacipran may be chosen as a treatment for patients with chronic dizziness with comorbid psychiatric disorders in case of and insufficient response to SSRIs.

Topics: Anxiety Disorders; Chronic Disease; Comorbidity; Cyclopropanes; Depressive Disorder; Dizziness; Female; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged; Milnacipran; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors

Topics: Anxiety Disorders; Cataract; Depressive Disorder; Female; Fluvoxamine; Humans; Lens Implantation, Intraocular; Lens, Crystalline; Phacoemulsification; Selective Serotonin Reuptake Inhibitors; Vision Disorders; Visual Acuity; Young Adult

In the present study, we examined the effect of N-acetyl-L-cysteine (NAC), a glutamate-modulating agent, on marble-burying behavior in mice. Fluvoxamine (30 mg/kg, p.o.) and mirtazapine (3 mg/kg, i.p.) significantly inhibited marble-burying behavior without affecting locomotor activity. Similarity, NAC (150 mg/kg, i.p.) significantly inhibited marble-burying behavior without affecting locomotor activity. On the other hand, the antioxidant α-tocopherol (10, 30, and 100 mg/kg, p.o.) had no effect on the marble-burying behavior. These results suggest that the glutamatergic system is involved in the marble-burying behavior, and NAC may be useful for treatment of OCD.

Topics: Acetylcysteine; alpha-Tocopherol; Animals; Antipsychotic Agents; Anxiety Disorders; Behavior, Animal; Fluvoxamine; Male; Mianserin; Mice; Mice, Inbred ICR; Mirtazapine; Motor Activity; Obsessive-Compulsive Disorder

We recently encountered a patient with pervasive developmental disorder not otherwise specified (PDDNOS), in whom complication by social anxiety disorder (SAD) was diagnosed at age 19, and who responded well to fluvoxamine therapy. The patient was a 19-year, 10-month-old male. He first visited our department at the age of 11 years and 3 months with the chief complaint of maladaptive behavior at school, when he was diagnosed as having PDDNOS. He was subsequently managed as an outpatient, with symptomatic alleviation in response to treatment. Recently, he visited our department again with the chief complaint of phobia of eye contact with other people. Based on the diagnosis of PDDNOS complicated by SAD, fluvoxamine therapy was initiated, which resulted in alleviation of the phobia against his own glance. Our experience with this case suggests that treatment with selective serotonin reuptake inhibitors can be effective in patients with PDDNOS complicated by SAD. Further study of patients with PDD associated with SAD, including evaluation of drug therapy, in additional cases is warranted.

Topics: Adult; Anxiety Disorders; Child; Child Development Disorders, Pervasive; Fluvoxamine; Humans; Male; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Social Behavior Disorders; Treatment Outcome; Young Adult

The aim of this study was to examine the psychopharmacological effects of antidepressants on post-ischemic rats. Global transient cerebral ischemia was performing with the four-vessels occlusion method. Locomotor activity, neurological scores and activity during the 20 min forced swimming test (FST) session were comparatively evaluated in sham-operated and ischemic animals. Three doses of four antidepressants or saline were then intraperitoneally administered 23.5, 5 and 1h before the 5 min FST session, and 0.5h before the elevated plus-maze (EPM). Histological quantification of neuronal loss was performed at the end of the experiments. Results show that before treatment, ischemic animals present significantly greater spontaneous motor activity, a neurological score and an immobility time in the 20 min FST lower than sham-operated animals. After treatment, compared to the saline group, we show an antidepressant-like activity in the FST with all the molecules, except with the fluvoxamine, and an anxiolytic-like effect in the EPM, with at least one dose of each compounds. The observed effect is very similar according to whether or not the animals were ischemic, with a tendency to react more important for ischemic animals versus sham-operated. This difference is significant in the FST for the immobility time and in the EPM for the ratio of distance, of time, of number of entrances and non-protected head dips with the 45 mg dose of milnacipran. These results demonstrate that even though global transient cerebral ischemia induces important cerebral lesions, it modifies little the effects of the different antidepressants, whatever their primary pharmacological target, with a particular effectiveness with the dual serotonin and norepinephrine reuptake inhibitor milnacipran.

Topics: Analysis of Variance; Animals; Antidepressive Agents; Anxiety Disorders; Behavior, Animal; Brain Ischemia; Cyclopropanes; Depressive Disorder; Desipramine; Disease Models, Animal; Dose-Response Relationship, Drug; Exploratory Behavior; Fluvoxamine; Hippocampus; Imipramine; Immobility Response, Tonic; Male; Milnacipran; Motor Activity; Rats; Rats, Wistar

There are a lot of studies on depressive disorders in a general hospital done across the world, but no data from Russia on this subject was found in international psychiatric journals or MEDLINE.. to determine the prevalence of depressive disorders in medical inpatients in Izhevsk, the capital of the Udmurt Republic, a region in Russia, and to identify associated factors.. A sample of 323 adult medical inpatients was composed. The Russian version of the MINI 5.0.0 was used.. The prevalence of lifetime and current depressive disorders was 30% and 20.7%, respectively. Depression was more common in women, widowed or divorced, retired or disabled, with low income and bad family relationships, and among respondents with a chronic somatic illness. Depression had a high comorbidity with organic mental and anxiety disorders. Only 40.3% of the individuals with depression had referred for psychiatric consultations, most of them being treated with fluvoxamine.. Prevalence of depression was substantial but consistent with other studies. Taking into consideration associated factors, physicians can improve recognition and treatment of depression in medical inpatients.

Topics: Adolescent; Adult; Antidepressive Agents, Second-Generation; Anxiety Disorders; Comorbidity; Cross-Cultural Comparison; Cross-Sectional Studies; Depressive Disorder; Female; Fluvoxamine; Hospitals, General; Humans; Male; Mental Disorders; Middle Aged; Neurocognitive Disorders; Referral and Consultation; Russia; Socioeconomic Factors; Young Adult

Topics: Adolescent; Anxiety Disorders; Electrocardiography; Female; Fluvoxamine; Humans; Long QT Syndrome; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Anxiety Disorders; Area Under Curve; Child; Delayed-Action Preparations; Drug Approval; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; United States; United States Food and Drug Administration

It is often stated that depressive phenomenology and prognosis differ between elderly and younger depressed patients, in the direction of more severe symptoms and a poorer outcome in elderly individuals. However, studies addressing the topic remain largely inconclusive, and it has been suggested that potential biases connected with age may have confounded previous assessments. In this work we evaluated a sample of 93 elderly depressed individuals (>60 years) and 186 younger patients. All patients were assessed with the 21-item Hamilton Depression Rating Scale at intake and prospectively followed for 6 weeks during treatment with antidepressants. A number of clinical and demographic features were taken into account to investigate depressive phenomenology and outcome in late-life depression. We found that the high likelihood of medical disorders in elderly patients explained the more severe depressive symptomatology observed in this population. However, independently from physical problems, recovery was slightly slower in elderly compared with younger individuals. Finally, patients who developed their first lifetime episode late in life (>60 years) showed a form of symptomatology similar to that in elderly patients with an earlier onset, but they showed a more positive outcome. In conclusion, the present work suggests that depression in old age is similar to depression in other ages, except for a slightly slower response to pharmacotherapy. Minor health problems increase the severity of depression, but they do not interfere crucially with the efficacy of antidepressant treatment. Finally, late-onset depression is associated with a positive outcome.

Topics: Adult; Age Factors; Aged; Antidepressive Agents; Anxiety Disorders; Bipolar Disorder; Cyclohexanols; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Middle Aged; Paroxetine; Personality Inventory; Sertraline; Treatment Outcome; Venlafaxine Hydrochloride

To determine the pharmacokinetics of fluvoxamine in children and adolescents and to compare pharmacokinetic data from adolescents to adults from a previous study.. Fluvoxamine was titrated to a target dose of 100 mg b.i.d. in children (6-11 years) and 150 mg b.i.d. in adolescents (12-17 years) with obsessive-compulsive disorder or other disorder requiring fluvoxamine treatment. Serum samples were collected over 12 hours after 12 or more consecutive doses of 25, 50, 100, and 150 mg.. Sixteen children (seven females, nine males) and 18 adolescents (nine females, nine males) were included in the pharmacokinetic analyses. Children demonstrated higher mean peak plasma concentration, higher mean area under the plasma concentration-time curve, and lower apparent oral clearance compared with adolescents. Compared with male children, female children had higher mean area under the plasma concentration-time curve, higher mean peak plasma concentration, and more reports of adverse events. However, the area under the plasma concentration-time curve was not directly correlated with frequency or severity of adverse events. Pharmacokinetics were nonlinear over the dose range studied. No pharmacokinetic differences were apparent between adolescents and adults on 150 mg b.i.d.. These pharmacokinetic results suggest that children (especially females) have a higher exposure to fluvoxamine than adolescents, whereas adolescents and adults appear to have similar exposure to fluvoxamine.

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Child; Cytochrome P-450 CYP2D6; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder

An 82-year-old man with treatment-resistant depression and early Alzheimer's disease was started on methylphenidate. Significant obsessive-compulsive behavior ensued but diminished over several weeks when methylphenidate was replaced by fluvoxamine. The patient had no prior psychiatric history, but he had a sister with obsessive-compulsive disorder. It appears that methylphenidate precipitated the patient's pathological behavior.

Topics: Aged; Aged, 80 and over; Anti-Anxiety Agents; Antidepressive Agents, Second-Generation; Anxiety Disorders; Buspirone; Central Nervous System Stimulants; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluvoxamine; Follow-Up Studies; Humans; Male; Methylphenidate; Obsessive-Compulsive Disorder

Topics: Adolescent; Anxiety Disorders; Child; Child, Preschool; Clinical Trials as Topic; Female; Fluvoxamine; Humans; Liver Failure; Male; Nausea; Psychopharmacology; Psychotropic Drugs; Research Design; Safety; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

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

Topics: Adolescent; Amphetamine-Related Disorders; Antidepressive Agents; Antitussive Agents; Anxiety Disorders; Child; Dextromethorphan; Diagnosis, Differential; Drug Interactions; Female; Fluvoxamine; Hallucinogens; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine; Obsessive-Compulsive Disorder; Seizures; Selective Serotonin Reuptake Inhibitors; Serotonin Agents; Serotonin Syndrome; Sertraline

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Anxiety, Separation; Child; Combined Modality Therapy; Female; Fluvoxamine; Humans; Male; Phobic Disorders; Psychotherapy; Selective Serotonin Reuptake Inhibitors

The aim of this paper is to describe a case of increased libido during fluvoxamine therapy.. Single case report.. The patient, a 27-year-old married Japanese woman with borderline personality disorder, developed an increased libido with the administration of fluvoxamine. The increased libido disappeared after fluvoxamine was discontinued.. The present findings suggest that fluvoxamine can cause increased libido in some patients.

Topics: Adult; Anxiety Disorders; Depression; Female; Fluvoxamine; Humans; Libido; Selective Serotonin Reuptake Inhibitors

Topics: Adolescent; Antidepressive Agents, Second-Generation; Anxiety Disorders; Child; Fluvoxamine; Humans; Selective Serotonin Reuptake Inhibitors; United States

Topics: Adolescent; Anti-Anxiety Agents; Anxiety Disorders; Child; Environment; Fluvoxamine; Humans; Selective Serotonin Reuptake Inhibitors

The authors present data from an open trial of fluvoxamine (median daily dosage: 200 mg) in the treatment of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder in 19 older outpatients (mean age = 66.8). Of the 12 subjects completing the 21-week trial, 8 achieved a good response (50% reduction in symptom measures) and 7 were rated as much or very much improved. Fluvoxamine pharmacotherapy also had a significant effect in reducing comorbid depressive symptoms and in increasing levels of functioning. These data support the effectiveness of fluvoxamine in older subjects with anxiety disorders (particularly generalized anxiety disorder) and warrant further double-blind, placebo-controlled evaluation.

Topics: Aged; Ambulatory Care; Anxiety Disorders; Comorbidity; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluvoxamine; Humans; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Treatment Outcome

Many patients with affective illness show partial or otherwise unsatisfactory responses to standard treatments, encouraging trials of combinations of pharmacologically dissimilar antidepressants.. Records of consecutive outpatients with affective disorders only partially responsive to treatment with a serotonin reuptake inhibitor (SRI) or bupropion, alone, were reviewed for changes in specific symptoms and risks of adverse events when an SRI and bupropion were combined.. Greater symptomatic improvement was found in 19 (70%) of 27 subjects during a mean +/- SD of 11 +/- 14 months of combined daily use of bupropion (243 +/- 99 mg) with an SRI (31 +/- 16 mg fluoxetine-equivalents) than with either agent alone. Adverse effect risks were similar to those associated with each monotherapy, with a > 10% incidence of sexual dysfunction (N = 11, 41%), insomnia (N = 6, 22%), anergy (N = 4, 15%), and tremor (N = 3, 11%) during combined therapy; there were no seizures.. With conservative dosing and close monitoring, combinations of SRIs with bupropion in this uncontrolled clinical series appeared to be safe and often more effective than monotherapy.

Topics: 1-Naphthylamine; Adult; Aged; Ambulatory Care; Anxiety Disorders; Bupropion; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Dysthymic Disorder; Epilepsy; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

An analysis is presented of a longitudinal study of fluvoxamine, an antidepressant drug, with ordinal responses, regressed on a combination of discrete and continuous covariates and with a substantial proportion of dropouts. Classical methods, such as weighted least squares (SAS procedure CATMOD) and logistic regression, are not suitable for the analysis of such data. Instead, we illustrate how a recently introduced model can be used to solve most of the problems posed. The method is likelihood-based and is an extension of the bivariate Dale model to an arbitrary number of outcomes. The method is suitable for several types of designs commonly employed in clinical trials.

Topics: Antidepressive Agents, Second-Generation; Anxiety Disorders; Data Interpretation, Statistical; Depression; Fluvoxamine; Humans; Likelihood Functions; Longitudinal Studies; Models, Statistical; Patient Dropouts

The selective serotonin reuptake inhibitor (SSRI) fluvoxamine has been used in an attempt to understand whether there is a biological distinction among anxiety disorders. A comparison of fluvoxamine with the specific noradrenaline reuptake inhibitor maprotiline in patients with panic disorder showed fluvoxamine to be a potent anti-panic agent, whereas maprotiline had no effect on the frequency of panic attacks. This result supported the hypothesis of serotonergic involvement in the pathogenesis of panic disorder. In a second study, unlike fluvoxamine, the 5-HT2A/2C antagonist ritanserin had no effect on the number of panic attacks, or phobic avoidance. This suggested that the efficacy of antidepressants in panic disorder was not a result of down-regulation of postsynaptic 5-HT2 receptors. Most studies suggest that the efficacy of antidepressants in obsessive-compulsive disorder (OCD) is not related to their antidepressant or mood-enhancing effects. Fluvoxamine has also been shown to reduce general and phobic anxiety in social phobia patients. In conclusion, serotonergic systems are implicated in the pathophysiology of global anxiety irrespective of the nosological background, and SSRIs, exemplified by fluvoxamine, appear to be effective in panic disorder, OCD and probably also social phobia.

Topics: Anxiety Disorders; Fluvoxamine; Humans; Maprotiline; Obsessive-Compulsive Disorder; Panic; Receptors, Serotonin; Ritanserin; Selective Serotonin Reuptake Inhibitors; Time Factors

Prescription-event monitoring (PEM) is one of two national systems of drug safety monitoring practised in Britain. The objective of this PEM study was to assess the safety of fluvoxamine and to monitor the occurrence of untoward and other events during treatment. A total of 10,401 patients treated with the drug in general practices throughout England were studied and data were analysed in the Drug Safety Research Unit, Southampton. The main outcome measures were the overall incidence of events per 1000 patients; the incidence during the first month of treatment; the mean incidence for months 2-6 of treatment; and the ratio of these rates as a signal that an event could be drug related. The most commonly reported category of events was neuropsychiatric while the most commonly reported individual events were nausea and vomiting. Fluvoxamine was shown to be a safe drug and no unexpected or previously undetected drug-related events were encountered. There was a relatively high incidence of gastro-intestinal symptoms, but other adverse reactions often encountered during treatment with tricyclic antidepressants were not frequently reported.

Topics: Adolescent; Adult; Aged; Anxiety Disorders; Depressive Disorder; Drug Monitoring; Drug Prescriptions; Drug Therapy, Combination; England; Family Practice; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Pregnancy; Product Surveillance, Postmarketing; Sex Factors

Obsessive-compulsive disorder (OCD) is an intriguing, difficult problem characterized by anxiety-producing intrusive thoughts and performance of anxiety-reducing rituals. Current evidence suggests that OCD may be associated with dysregulation of serotonin and dopamine neurotransmission. Numerous early studies involving the serotonin-specific reuptake inhibitor clomipramine led to the formulation of this hypothesis. Positive results with clomipramine initiated further research with other serotonin-specific reuptake inhibitors, such as fluoxetine, fluvoxamine, sertraline, and serotonergic agents such as buspirone and trazodone. Findings from a number of clinical trials suggest that drugs that inhibit serotonin reuptake or affect serotonergic transmission in other ways are of clear benefit in the treatment of OCD. These drugs may be more effective for obsessive thoughts than for compulsive rituals. Effective pharmacotherapy can dramatically decrease obsessive-compulsive symptoms and improve the patient's quality of life.

Topics: 1-Naphthylamine; Antidepressive Agents; Anxiety Disorders; Clomipramine; Depression; Dopamine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Serotonin; Sertraline; Synaptic Transmission; Trazodone

We evaluated patients abruptly withdrawn from fluvoxamine, a serotonin selective reuptake inhibitor, for evidence of a discontinuation syndrome.. In an open-label study, 14 subjects were abruptly withdrawn from fluvoxamine after treatment lasting 8 months (7 months for 1 patient). Psychological, somatic, and perceptual symptoms were assessed at Day 5, Day 10, and Day 14 postdiscontinuation. Anxiety and depression were assessed using clinician and self-rated scales.. Twelve (86%) of 14 subjects developed new symptoms. The most frequent symptoms reported were dizziness/incoordination, headaches, nausea, and irritability. Symptoms peaked on Day 5 postdiscontinuation. Only 1 subject had a recurrence of panic, but another developed anxiety and depression; both were remedicated.. Abrupt fluvoxamine discontinuation is associated with a characteristic syndrome in many patients.

Topics: Adult; Anxiety Disorders; Depressive Disorder; Dizziness; Female; Fluvoxamine; Follow-Up Studies; Humans; Male; Panic Disorder; Psychiatric Status Rating Scales; Recurrence; Severity of Illness Index; Substance Withdrawal Syndrome; Syndrome

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

The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Oximes; Psychiatric Status Rating Scales; Psychometrics; Sensitivity and Specificity; Severity of Illness Index

Topics: Adult; Anxiety Disorders; Fear; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Oximes; Panic