fluvoxamine and Bipolar-Disorder

Topics: Adult; Antidepressive Agents; Bipolar Disorder; Citalopram; Commerce; Compulsive Behavior; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Middle Aged; Panic Disorder

The aim of the present study was to test a possible effect of the A218C tryptophan hydroxylase (TPH) gene variant on the antidepressant activity of fluvoxamine in a sample of major and bipolar depressives, with or without psychotic features. Two hundred and seventeen inpatients were treated with fluvoxamine 300 mg and either placebo or pindolol in a double blind design for 6 weeks. The severity of depressive symptoms was weekly assessed with the Hamilton Rating Scale for Depression. TPH allelic variants were determined in each subject by using a PCR-based technique. No significant finding was observed in the overall sample as well as in the pindolol group, while TPH*A/A was associated with a slower response to fluvoxamine treatment in subjects not taking pindolol (P = 0.001). This effect was independent from the previously reported influence of 5-HTTLPR polymorphism. If confirmed, these results may shed further light on the genetically determined component of the response to pharmacological treatments, thus helping the clinician to individualize each patient's therapy according to their genetic pattern.

Topics: Adult; Age of Onset; Alleles; Antidepressive Agents, Second-Generation; Bipolar Disorder; Carrier Proteins; Delusions; Depressive Disorder; Drug Synergism; Female; Fluvoxamine; Genetic Variation; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Middle Aged; Nerve Tissue Proteins; Pindolol; Polymerase Chain Reaction; Predictive Value of Tests; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins; Tryptophan Hydroxylase

It has been recently reported that the short variant of the serotonin transporter (5-HTT) gene-linked functional polymorphic region (5-HTTLPR) influences the antidepressant response to certain selective serotonin reuptake inhibitors. The aim of the present study was to test this finding in a sample of major and bipolar depressives, with or without psychotic features.. One hundred fifty-five inpatients were treated with fluvoxamine 300 mg and either placebo or pindolol in a double-blind design for 6 weeks. The severity of depressive symptoms was weekly assessed with the Hamilton Rating Scale for Depression. Allelic variation of 5-HTTLPR in each subject was determined using a polymerase chain reaction-based technique.. 5-HTTLPR short variant was associated with a poor response to fluvoxamine treatment, independently from the recorded clinical variables. More specifically, the diagnosis, the presence of psychotic features, and the severity of depressive symptomatology did not influence this association. Conversely, pindolol augmentation may ameliorate the rate of response in 5-HTTLPR short variant subjects, thus reducing the difference in the response rate among the genotype variants.. If confirmed, these results may improve patient care by helping the clinician to individualize treatment according to the patient's genetic 5-HTTLPR pattern.

Topics: Adult; Antidepressive Agents; Bipolar Disorder; Carrier Proteins; Delusions; Depressive Disorder, Major; Double-Blind Method; Drug Therapy, Combination; Female; Fluvoxamine; Genetic Variation; Genotype; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Middle Aged; Nerve Tissue Proteins; Pindolol; Polymorphism, Genetic; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins; Treatment Outcome

Topics: Adult; Aged; Bipolar Disorder; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors

The molar ratio of total plasma tryptophan (Trp) to the sum of the other large neutral amino acids (LNAAs), thought to reflect brain serotonin (5-HT) formation, was estimated in 47 patients with major depression (unipolar and bipolar) before and after 6 weeks of treatment with a serotonin uptake inhibitor, fluvoxamine. We found a significant difference between responders (n = 39) and nonresponders (n = 8) for the pre- and in-treatment plasma Trp to LNAAs ratios. In contrast, there were no differences between the two groups for the mean plasma steady-state fluvoxamine levels. These findings suggest that a specific plasma amino acid profile may be a useful indicator of good clinical response to a selective 5-HT uptake inhibitor.

Topics: Adult; Aged; Amino Acids; Bipolar Disorder; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Humans; Male; Middle Aged; Personality Inventory; Tryptophan

The efficacy of fluvoxamine was compared to that of amitriptyline in a double-blind 6-week fixed-dose trial of 56 inpatients with major depressive episode. The two drugs were comparable in their antidepressant efficacy. We tested the percentage of improvement in Hamilton-D scores during the first and the second weeks of treatment as predictors of efficacy for the last week. Improvement rates during the second week significantly predicted the outcome. We also investigated whether or not some symptomatological characteristics would permit prior prediction of the outcome with amitriptyline or fluvoxamine, dividing our sample into responders and nonresponders to the two drugs. The four groups showed differences in their symptomatological profiles.

Topics: Adult; Aged; Amitriptyline; Bipolar Disorder; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Personality Inventory; Recurrence

The study of a sample of 189 inpatients with the diagnostic of Major Depressive Disorder (DSM III-R) treated with fluvoxamine showed: a good compromise efficacy/tolerance in 75% of cases; an interruption of treatment in 25% of cases, schematically divided in early gastric intolerance and in late resistance. 2.5% of manic switches have been observed and contribued, with this pattern of good results, to confirm the major antidepressant activity and good tolerance of fluvoxamine.

Topics: Bipolar Disorder; Depressive Disorder; Fluvoxamine; Hospitalization; Humans; Time Factors

Antidepressants are ineffective in about 30% of patients with major depression. Some authors then advise treatment of non-responders with (non-tricyclic) more selective reuptake inhibitors. In a double-blind, partial crossover study, 71 patients were selected for treatment during 4 weeks with oxaprotiline and/or fluvoxamine, two non-tricyclic antidepressants that are selective reuptake inhibitors or noradrenaline and serotonin respectively. All patients had failed to respond to earlier treatment with cyclic antidepressants during the current episode. Only 13% of the patients responded, with 27% of them responding to oxaprotiline and none to fluvoxamine. Moreover, a low response of 27% was also obtained in the crossover phase, which included all non-responders to the first treatment, oxaprotiline being effective in 39% and fluvoxamine in 10% of the patients. The results indicate that selective reuptake inhibitors are not an effective alternative for non-responders to other cyclic antidepressants and that non-responders to "noradrenergic" antidepressants do not appear to have much chance of responding to "serotonergic" antidepressants and vice versa.

Topics: Adult; Anthracenes; Bipolar Disorder; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Maprotiline; Middle Aged; Oximes; Personality Disorders; Psychological Tests; Psychometrics

1 Two double-blind, randomised studies were performed to compare the efficacy of fluvoxamine and chlorimipramine in depressed patients. In the first study the effects of a single daily dosage of between 100 and 300 mg of fluvoxamine were compared with those of chlorimipramine at a dosage of 50-150 mg daily in 43 out-patients with endogenous depression. 2 In a second study using three times daily dosing with a daily dosage of 150-300 mg for both fluvoxamine and chlorimipramine, 30 in-patients with unipolar depression were assessed. 3 Four weeks of treatment with single daily dosing resulted in a mean improvement of 61.4% (+/- s.d. 31.7) on the Hamilton Rating Scale for Depression (HAMD) for fluvoxamine and of 65.3% (+/- s.d. 25.8) for chlorimipramine. In the study with three times daily dosing the mean results were 72.9% (+/- s.d. 22.3) improvement for fluvoxamine and 62.1% (+/- s.d. 28.5) for chlorimipramine. 4 At similar dosages, fluvoxamine had significantly less untoward effects on blood pressure than chlorimipramine. Anticholinergic effects were also fewer in the fluvoxamine group, as were nervous system symptoms, with the latter difference reaching statistical significance (P = 0.02). 5 We conclude that fluvoxamine, given in a single daily dose of 150-250 mg, provides antidepressant efficacy similar to chlorimipramine. At this dosage it may be expected to produce less anticholinergic effects and have less influence on blood pressure than chlorimipramine.

Topics: Adolescent; Adult; Aged; Antidepressive Agents; Bipolar Disorder; Clinical Trials as Topic; Clomipramine; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Hemodynamics; Humans; Male; Middle Aged; Oximes

Thirty patients were treated in a randomised double-blind efficacy study of fluvoxamine and chlorimipramine. The dose range for both drugs was 50-300 mg in divided daily doses. Mean daily doses were higher for fluvoxamine than chlorimipramine. Generally the baseline recordings were comparable for both drug groups. Fluvoxamine was superior to chlorimipramine in all the rating scales used without achieving statistical significance. Chlorimipramine, but not fluvoxamine, caused a significant decrease in blood pressure. There were no significant effects on ECG or laboratory variables. There was no significant relationship between plasma levels of either compound or metabolite and clinical response. Chlorimipramine exerted more unwanted effects than fluvoxamine. Autonomic effects of fluvoxamine were minimal in comparison with chlorimipramine. Chlorimipramine patients required more concurrent anxiolytic medication than fluvoxamine. Both drug groups required a significant amount of concurrent hypnotic medication.

Topics: Adolescent; Adult; Antidepressive Agents; Bipolar Disorder; Clomipramine; Depressive Disorder; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Oximes; Psychiatric Status Rating Scales; Random Allocation

1. Fluvoxamine is a potent serotonin re-uptake inhibitor, with little or no noradrenergic or anticholinergic activity. 2. The results of three studies using an almost identical protocol with a prospectively randomized, double-blind design comparing fluvoxamine and chlorimipramine are presented. 3. In a population of 98 subjects suffering from a variety of depressive conditions, there was a marked improvement over four weeks in both groups. dosage was maintained between 150 and 300 mg per day. 4. There were no changes of clinical importance in vital signs, hematology or biochemistry, but pulse rates increased in the chlorimipramine group. 5. There were fewer concurrent signs and symptoms in the fluvoxamine group, especially those attributable to anticholinergic activity.

Topics: Antidepressive Agents; Bipolar Disorder; Clinical Trials as Topic; Clomipramine; Depressive Disorder; Double-Blind Method; Fluvoxamine; Humans; Oximes; Receptors, Serotonin

Topics: Adult; Affect; Antidepressive Agents; Antipsychotic Agents; Aripiprazole; Bipolar Disorder; Clomipramine; Depression, Postpartum; Diagnosis, Differential; Female; Fluvoxamine; Humans; Lithium Compounds; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales

Tetrahydrobiopterin (BH4) plays an important role in the biosynthesis of serotonin, melatonin and catecholamines, all of which are implicated in the pathophysiology of mood disorders (MDs), including major depressive disorder (MDD) and bipolar disorder (BP). Production of BH4 is regulated by GTP cyclohydrolase transcription and activity. Thus, we considered the GTP cyclohydrolase gene (GCH1) to be a good candidate gene in the pathophysiology of MDs and of the serotonin selective reuptake inhibitors (SSRIs) response in MDD, and conducted a case-control study utilizing three SNPs (rs8007267, rs3783641 and rs841) and moderate sample sizes (405 MDD patients, including 262 patients treated by SSRIs, 1022 BP patients and 1805 controls).. A multiple logistic regression analysis was carried out to compare the frequencies of each SNP genotype for the target phenotype across patients and controls in several genetic models, while adjusting for possible confounding factors. A clinical response was defined as a decrease of more than 50% from the baseline score on the Structured Interview Guide for Hamilton Rating Scale for Depression (SIGH-D) within 8 weeks, and clinical remission as a SIGH-D score of less than 7 at 8 weeks.. No associations between three SNPs in GCH1 and MDD or BP were observed; however, GCH1 was associated with SSRI therapeutic response in MDD in all the marker's haplotype analysis (Global P value=0.0379).. Results suggest that GCH1 may predict response to SSRI in MDD in the Japanese population. Nevertheless, a replication study using larger samples may be required for conclusive results, since our sample size was small.

Topics: Adult; Antidepressive Agents; Asian People; Bipolar Disorder; Case-Control Studies; Depressive Disorder, Major; Female; Fluvoxamine; Gene Frequency; Genotype; GTP Cyclohydrolase; Haplotypes; Humans; Logistic Models; Male; Middle Aged; Phenotype; Polymorphism, Single Nucleotide; Selective Serotonin Reuptake Inhibitors

A polymorphism within the serotonin transporter gene (SERTPR) has been repeatedly associated to mood disorders and response to SSRIs treatment. Recent evidence suggested that influence of genetic effect of SERTPR might be modulated by stress, particularly as regard the development of anxious-depressive symptoms. Nevertheless, there is no information about the role of stressors as potential modulator of SERTPR effects on depressive outcome during pharmacological treatment. In a sample of 159 mood disorder patients treated with fluvoxamine, we found stressors preceding the onset of the illness significantly influencing the genetic effect exerted by SERTPR on response after 6 weeks of treatment. This preliminary finding supports the idea of complex interaction between biological and environmental factors underlying the efficacy of biological treatments, other than liability for mood disorders. Nevertheless, many limitations characterize the present investigation and well-funded studies on larger samples are required.

Topics: Antidepressive Agents; Antidepressive Agents, Second-Generation; Bipolar Disorder; DNA; Fluvoxamine; Humans; Mood Disorders; Psychiatric Status Rating Scales; Serotonin Plasma Membrane Transport Proteins; Stress, Psychological

Artificial neural networks (ANN) represent a promising tool for combining multiple predictors in complex diseases. Antidepressant response in mood disorders is a typical complex phenomenon were a number of predictors influence outcome under non-linear interactions. In the present study we tested a neural network strategy for antidepressant outcome in subjects affected by major depression. One hundred and forty-five never reported depressed inpatients were included in this study (major depressives/bipolars: 111/34). A multi layer perceptron network composed of 1 hidden layer with 13 nodes was chosen. The network was performed on the sample of 145 cases divided as follows: train 73+verify 36+test 36. Correlation of predicted versus observed response was 0.46 in the test (independent) sample that corresponds to 21% of variance explained. Number of episodes, side effects, delusional features, baseline HAM-D, length of current episode, lithium augmentation, current medical condition and personality disorders were the main factors identified by the model. Sex, age at onset, polarity, plasma level and baseline VAS score were part of the model but with a lower rank. Overall, our findings suggest that neural networks could be a valid technique for the analysis of psychopharmacology studies. The complex interactions modelled through ANN may be eventually applied at the clinical level for the individualized therapy.

Topics: Antipsychotic Agents; Bipolar Disorder; Delusions; Demography; Depressive Disorder, Major; Dose-Response Relationship, Drug; Female; Fluvoxamine; Humans; Incidence; Lithium Carbonate; Male; Middle Aged; Nerve Net; Personality Disorders; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

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

A functional insertion/deletion (*l/*s) repeat polymorphism within the promoter region of the serotonin transporter (5-HTTLPR) has been described. An association between *l variant and a better and faster response to serotonin selective reuptake inhibitors in depressed patients was reported in Caucasians. The value of the explained variance due to the 5-HTTLPR, however, was 7% only, and different *l and *s variants were reported according to the nucleotide sequence of repeats. In this study, we investigated the antidepressant response to fluvoxamine in individuals carrying different *l and *s variants according to the Nakamura findings. Two hundred and twenty-eight patients affected by bipolar disorder and major depression were administered a daily dose of fluvoxamine up to 300 mg and evaluated at baseline and weekly thereafter until week 7, using the 21-item Hamilton Rating Scale for Depression. We found a marginally significant difference in genotype and allele (P=0.04, data not shown) distribution (*l and *s traditional variants) according to diagnosis (bipolar disorder vs. major depression). We confirmed a better and faster response in our depressed patients bearing the *l variant, but we also found significant differences in response among *l carriers according to the type of *l allele. In fact, 16F *l carriers showed only a partial response, while 16D *l carriers showed a marginally significantly better response than 16A *l allele carriers. These results, although very preliminary, can represent a further step toward a better understanding of the molecular genetics of antidepressant response.

Topics: Adult; Base Sequence; Bipolar Disorder; Depressive Disorder; DNA; DNA Primers; Female; Fluvoxamine; Gene Frequency; Genetic Carrier Screening; Genetic Variation; Humans; Male; Middle Aged; Polymorphism, Genetic; Repetitive Sequences, Nucleic Acid; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins

Topics: Adult; Bipolar Disorder; Depressive Disorder; Female; Fluvoxamine; Humans; Methamphetamine; Selective Serotonin Reuptake Inhibitors; Substance Withdrawal Syndrome

Selective serotonin reuptake inhibitors (SSRIs) and dual serotonin and noradrenaline reuptake inhibitors (SNRIs) are the most commonly prescribed class of antidepressants, yet it is not known whether one is superior to another.. The purpose of this clinical practice was to compare the periods of onset of action of fluvoxamine, paroxetine and milnacipran.. A retrospective cohort analysis was carried out among out-patients with depression treated in the Department of Psychiatry, Kawasaki Medical School Hospital, Kurashiki, Japan, in 2000 and 2001. A total of 206 patients receiving fluvoxamine, paroxetine and milnacipran were identified.. The cumulative percentage of responders receiving milnacipran reached over 80% after 4 weeks, but it did reach this level for fluvoxamine or paroxetine until after 6 weeks.. The differential period of onset of action should help guide clinicians in determining a suitable duration of antidepressants for depression.

Topics: Antidepressive Agents; Bipolar Disorder; Cyclopropanes; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Middle Aged; Milnacipran; Outpatients; Paroxetine; Psychiatric Status Rating Scales; Retrospective Studies; Time Factors; Treatment Outcome

Although it is well established that the diagnosis and treatment of depression in the elderly are major health care problems, the relative efficacy of antidepressant treatment in the elderly compared with younger adults has not been definitively established. In this study, we analyzed antidepressant response in 528 nondemented consecutive inpatients affected by a major depressive episode. The sample was divided based on a cut-off of 60 years (< or = 60 n = 354; mean age 46.6 +/- 10.4 years; > 60 n = 174; mean age 66.1 +/- 4.2 years); all the patients were treated with fluvoxamine for at least 6 weeks and they were assessed weekly by using the Hamilton Rating Scale for Depression. Fluvoxamine proved to be effective in our elderly sample, even if antidepressant response was lower in the elderly compared with that of younger subjects (chi2 = 6.27, P = 0.01). Moreover, when compared with younger subjects, the older ones showed significantly slower reduction of depressive symptoms (P = 0.0006). This difference between the 2 age groups was evident since the 2nd week of treatment, and it appeared to be independent of other clinical variables.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antidepressive Agents, Second-Generation; Bipolar Disorder; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Middle Aged; Psychological Tests; Retrospective Studies; Time Factors; Treatment Outcome

Topics: Adrenergic Uptake Inhibitors; Adult; Antidepressive Agents, Second-Generation; Bipolar Disorder; Cohort Studies; Cyclopropanes; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Male; Middle Aged; Milnacipran; Paroxetine; Personality Inventory; Psychometrics; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Sex Factors; Treatment Outcome

The safety profile of the selective serotonin reuptake inhibitor, fluvoxamine, has been assessed in clinical and post-marketing studies. Post-marketing surveillance provides the opportunity to assess a drug's safety in every day clinical conditions in a much greater patient population than in clinical trials and therefore serves as a useful tool to detect signals for adverse effects with an incidence of less than 1 : 10,000. The safety profile of fluvoxamine was evaluated based on data from 17 years of global post-marketing surveillance in an estimated 28 million patients exposed to fluvoxamine. A total of 6,658 adverse drug reaction reports received from world-wide sources were reviewed and analysed. Post-marketing surveillance data confirmed the favourable safety profile already observed in clinical and post-marketing studies. A remarkably low level of suicidality, switch to mania, and sexual dysfunction was found. Serotonin syndrome appeared to be a very rare complication of fluvoxamine treatment. No signals for drug interactions unknown so far were identified. Withdrawal symptoms were observed in everyday clinical conditions, which were generally mild and resolved spontaneously. However, no cases suggestive for drug dependence have been reported. In conclusion, the data presented underlined that fluvoxamine offers a safe and well-tolerated option in the treatment of depression and obsessive-compulsive disorder.

Topics: Antidepressive Agents, Second-Generation; Bipolar Disorder; Cardiovascular Diseases; Death; Drug Interactions; Fluvoxamine; Humans; Product Surveillance, Postmarketing; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Sexual Dysfunctions, Psychological; Substance Withdrawal Syndrome; Suicide

The present report describes the behavioural and psychological changes in a 55-year-old depressed male who displayed hypomania after the use of fluvoxamine in addition to other antidepressant medications. The patient experienced his first major depressive episode after the bankruptcy of his company. When fluvoxamine was prescribed at a dose of 50 mg/day in addition to sulpiride at 150 mg/day and a 50 mg dose of trazodone before sleep seven months after admission, grinning and a violation of ward rules occurred repeatedly. The patient became verbally aggressive to the staff and addicted to gambling and alcohol. Six days after the cessation of fluvoxamine, his condition remitted. None of the neuromuscular abnormalities indicative of serotonin syndrome appeared during the episode. Upon review of previous reports on manic switches induced by SSRIs and other antidepressants, we speculate that the fluvoxamine accounted for his hypomania.

Topics: Bipolar Disorder; Depressive Disorder, Major; Drug Administration Schedule; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors

We assessed the pattern of changes in depressive symptoms in delusional depressed inpatients treated openly with 300 mg/day of fluvoxamine for 6 weeks. We studied 59 inpatients affected by bipolar (n=23) and major depressive (n=36) disorders with psychotic features (DSM-IV) who showed complete responses to fluvoxamine treatment. Responses were evaluated using the Hamilton Rating Scale for Depression (HAMD-21, divided into: Core, Activity, Psychic anxiety, Somatic anxiety and Delusion clusters) administered at baseline and weekly until the 6th week. Random Regression Model (RRM) analysis was used to investigate the longitudinal time course of HAMD clusters. HAMD depressive symptom clusters decreased in a parallel manner from baseline to the end of the 6-week trial. The RRM analysis revealed no significant difference between HAMD clusters and the time course of the total HAMD score during treatment. Our data indicate that there is a simultaneous decrease in depressive symptoms during antidepressant treatment of delusional depressives.

Topics: Adult; Antidepressive Agents, Second-Generation; Bipolar Disorder; Delusions; Depressive Disorder, Major; Female; Fluvoxamine; Humans; Longitudinal Studies; Male; Middle Aged; Personality Inventory; Psychiatric Status Rating Scales; Treatment Outcome

Lithium is a neurotoxin with a particular affinity for the cerebellum. The risk of permanent neurotoxic sequelae of lithium is increased by the concomitant use of certain conventional neuroleptics. We report two new cases of lithium neurotoxicity; one received lithium alone, not in combination with a neuroleptic. Both cases showed severe cerebellar atrophy on brain CT and MRI. Additional factors such as dehydration, systemic infection, other medications, or rapid correction of frequently-coexisting hyponatremia may contribute to the risk of lithium neurotoxicity. We discuss possible pathophysiologic mechanisms and preventive measures.

Topics: Antipsychotic Agents; Atrophy; Bipolar Disorder; Cerebellum; Drug Interactions; Drug Therapy, Combination; Female; Fluvoxamine; Follow-Up Studies; Humans; Lithium; Magnetic Resonance Imaging; Middle Aged; Nerve Degeneration; Psychotic Disorders; Time Factors

We prolonged from 24 to 36 months a follow-up study of unipolar subjects with a high probability of recurrence treated with fluvoxamine (n = 32) or lithium (n = 32). During the extra observation period, two patients developed mania and were excluded from the study. There were no further recurrences in either the lithium or the fluvoxamine group. In our sample, previous prescriptions of tricyclics seem to predict a worse prognosis.

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Antimanic Agents; Bipolar Disorder; Depressive Disorder; Female; Fluvoxamine; Follow-Up Studies; Humans; Lithium; Male; Recurrence; Treatment Outcome

Topics: Bipolar Disorder; Bradycardia; Female; Fluvoxamine; Humans; Middle Aged; Suicide, Attempted

Topics: Bipolar Disorder; Drug Interactions; Female; Fluvoxamine; Humans; Lithium; Middle Aged; Neuromuscular Diseases; Serotonin; Syndrome

To report cases of manic-like behavior induced by fluvoxamine, a selective serotonin-reuptake inhibitor; to review pertinent literature; and to encourage replication of our findings in larger patient samples.. Description of a case series of fluvoxamine-induced, manic-like behavior.. Eight patients with depression or obsessive features who developed manic-like behavior after initiation of fluvoxamine therapy.. Manic symptomatology resolved in all eight patients following dosage reduction or withdrawal of fluvoxamine. Four patients still are maintained on low-dose fluvoxamine without recurrent manic symptoms.. Our case series suggests that fluvoxamine may have the ability to induce or unmask manic behavior in depressed patients. Clinicians are alerted to monitor for this "switching" effect, especially in patients previously or currently treated with neuroleptics or lithium, and in those patients exhibiting characteristics of obsessive-compulsive disorder.

Topics: Adult; Bipolar Disorder; Depressive Disorder; Female; Fluvoxamine; Humans; Male; Middle Aged

Topics: Bipolar Disorder; Clomipramine; Dose-Response Relationship, Drug; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risk Factors

Topics: Adult; Bipolar Disorder; Depressive Disorder; Dose-Response Relationship, Drug; Female; Fluvoxamine; Humans; Male; Middle Aged; Patient Compliance; Platelet Count; Serotonin

Topics: Adult; Bipolar Disorder; Carbamazepine; Fluvoxamine; Humans; Lithium; Male

Topics: Adult; Amenorrhea; Bipolar Disorder; Female; Fluvoxamine; Galactorrhea; Humans; Loxapine

Topics: Adult; Bipolar Disorder; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Pregnancy; Pregnancy Complications; Substance Withdrawal Syndrome

Topics: Bipolar Disorder; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Topics: Adult; Antidepressive Agents; Bipolar Disorder; Depressive Disorder; Drug Interactions; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Lithium; Male; Oximes

Topics: Adult; Antidepressive Agents; Bipolar Disorder; Drug Overdose; Female; Fluvoxamine; Humans; Impulsive Behavior; Oximes

The erythrocyte membrane transport (MT) of L-tyrosine (TYR) and L-tryptophan (TRP) and their plasma concentration showed abnormal mean values in 37 depressed patients compared to control subjects before treatment. The pattern of these abnormal values differed according to the clinical subgroup (DSM III criteria). In bipolar disorders the TYR values were all low and the TRP values showed little change, except a low level of plasma TRP. In major depression, MT were abnormal (MT TYR low, MT TRP high) with a very low plasma TRP. In dysthymic disorders the TYR and TRP values were normal. The normalization of the above biochemical variables was significantly correlated with the clinical improvement; however, the plasma concentration of TRP remained abnormal in some patients who had recovered. In contrast, only plasma TYR and TRP were significantly increased in patients without recovery.

Topics: Adult; Aged; Antidepressive Agents; Bipolar Disorder; Depressive Disorder; Desipramine; Erythrocyte Membrane; Female; Fluvoxamine; Humans; Imipramine; Male; Middle Aged; Oximes; Psychological Tests; Tryptophan; Tyrosine