fluvoxamine and Mental-Disorders

Topics: Alzheimer Disease; Animals; COVID-19; COVID-19 Drug Treatment; Drug Repositioning; Fluvoxamine; Humans; Mental Disorders; Neoplasms; Post-Acute COVID-19 Syndrome; Psychotropic Drugs; Selective Serotonin Reuptake Inhibitors

Pharmacological treatments used for psychiatric disorders, such as clozapine, demonstrate large interindividual variability in terms of possible adverse effects and therapeutic benefit. This variability can be explained by multiple factors, including pharmacogenetic factors. Clozapine efficacy can be impacted by CYP polymorphisms. A growing body of literature on pharmacogenetics suggests the clinical benefit of concomitant use of clozapine and fluvoxamine to improve global pharmacotherapeutic management. This article reviews and discusses available clinical and pharmacological data and limitations of clozapine augmentation with fluvoxamine based on pharmacogenetic rationale and clinical experience. The aim is to provide an updated approach on how to use the pharmacological and pharmacogenetic profile to improve clozapine efficacy and tolerance in severely ill patients.

Topics: Antipsychotic Agents; Clozapine; Fluvoxamine; Humans; Mental Disorders; Pharmacogenetics; Psychiatry

Antidepressants are frequently prescribed and are the first-line pharmacological treatments for psychiatric disorders in children and adolescents. Although antidepressants are generally effective and well-tolerated by children, between 31% to 48% will not respond and up to 25% will experience an adverse drug reaction. Evidence from adult populations suggests pharmacogenetic information can assist with identifying individuals at greatest risk for poor response or adverse drug reactions but the evidence base in pediatric populations is less clear.. We systematically identified, reviewed, and critically evaluated the antidepressant pharmacogenetics literature among children and adolescents using standardized tools and consensus criteria.. We identified 24 studies, most of which were of fair to moderate quality. Collectively, the studies identified 25 significant gene-antidepressant associations involving 10 genes (ABCB1, BDNF, CYP2C19, CYP2D6, FKBP5, GNB3, HTR1B, HTR2A, SLC6A4, TPH2) and nine antidepressants (amitriptyline, citalopram, escitalopram, fluoxetine, fluvoxamine, nortriptyline, paroxetine, sertraline, and venlafaxine). None of the identified associations have been independently replicated in children.. Included studies were heterogenous in terms of study design, genes and drugs assessed, and outcomes measured.. The antidepressant pharmacogenetics knowledge base in pediatric populations is still emerging, but results to date echo many of the gene-antidepressant associations identified in adult populations. Given ubiquitous prescribing of antidepressants in the care of children and adolescents with psychiatric disorders, further research on identifying new and confirming current gene-antidepressant associations are warranted.

Topics: Adolescent; Amitriptyline; Antidepressive Agents; Child; Citalopram; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP2D6; Female; Fluoxetine; Fluvoxamine; Humans; Male; Mental Disorders; Nortriptyline; Paroxetine; Pharmacogenetics; Serotonin Plasma Membrane Transport Proteins; Sertraline; Tryptophan Hydroxylase; Venlafaxine Hydrochloride; Young Adult

New clozapine optimization strategies are warranted, as some patients do not achieve sufficient response and experience various adverse effects. Fluvoxamine is a potent CYP1A2 inhibitor and may increase the ratio of clozapine to its primary metabolite N-desmethylclozapine (NDMC).. This study aims to review all pharmacodynamic effects and the adverse effect profile of changing the clozapine/NDMC ratio with adjunctive fluvoxamine.. MEDLINE, Embase, and the Cochrane Library were searched with the search terms "clozapine" and "fluvoxamine" without any time limit. Language was restricted to English, Scandinavian, Polish, and German. Studies were sorted for relevance based on title and abstract. Clinical recommendations of potential indications/effects were graded as level A, B, C, or D depending on studies of high, moderate, low, or very low quality, respectively.. Based on data from 24 case reports/series, seven cohort studies, and two randomized controlled trials, 241 patients were studied. Evidence (A) supported that adjunctive fluvoxamine increased clozapine plasma levels. This may increase the probability of response in patients, where sufficient clozapine plasma levels cannot be achieved. Adjunctive fluvoxamine reduced metabolic adverse effects of clozapine (B) but not agranulocytosis risk (B). Although depressive or obsessive-compulsive symptoms may improve, a SSRI with no CYP1A2 inhibition should rather be used (C). No studies investigated the effect of adjunctive fluvoxamine to minimize clozapine rebound psychosis (D) or to reduce the effects of smoking on clozapine plasma levels (D).. Adjunctive fluvoxamine may have clinical potentials for optimizing clozapine treatment but further clinical studies are warranted to explore the clinical implications.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Clozapine; Drug Therapy, Combination; Fluvoxamine; Humans; Mental Disorders

The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Child; Depressive Disorder; Desipramine; Fatal Outcome; Female; Fluvoxamine; Forensic Psychiatry; Humans; Imipramine; Male; Malpractice; Mental Disorders; Psychopharmacology; Schizophrenia; Thioridazine

This article looks at the most common drugs that are in use in child psychiatry, and discusses their main indications for use and possible side effects.

Topics: Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Child; Child Psychiatry; Drug Prescriptions; Drug Utilization; Fluoxetine; Fluvoxamine; Health Policy; Humans; Melatonin; Mental Disorders; Methylphenidate; Needs Assessment; Patient Selection; Practice Guidelines as Topic; Practice Patterns, Physicians'; Propylamines; Psychotropic Drugs; Risperidone; Sertraline; United Kingdom

The discontinuation of many pharmacologic agents is associated with characteristic withdrawal symptoms. Antidepressants, particularly the tricyclic antidepressants (TCAs), are known to be associated with a group of common symptoms upon discontinuation. Serotonin reuptake inhibitors (SRIs) are also taking their respective place in the literature with reports of discontinuation symptoms. This review summarizes case reports and reports that allow systematic assessment of discontinuation symptoms following SRI discontinuation.. A computerized literature search was conducted using a MEDLINE search to identify reports of withdrawal effects following discontinuation of SRIs. Additional reports were found in the bibliographies of various published reports.. SRI discontinuation symptoms in adults are summarized in 24 case reports and 9 reports from controlled clinical trials. Additionally, 3 case reports addressing SRI discontinuation in the neonate are described. The reports describe clusters of symptoms commonly associated with the discontinuation of an SRI.. We propose to define an antidepressant discontinuation syndrome as the onset of a cluster of somatic and psychic symptoms following the discontinuation of an SRI and not attributable to other causes (e.g., concomitant medication, illness). These symptoms include dizziness, light-headedness, insomnia, fatigue, anxiety/agitation, nausea, headache, and sensory disturbance. The syndrome may last up to 3 weeks and may be improved by restarting the antidepressant or starting an antidepressant with a similar pharmacologic profile.

Topics: 1-Naphthylamine; Adolescent; Adult; Child; Clinical Trials as Topic; Cyclohexanols; Dizziness; Female; Fluoxetine; Fluvoxamine; Headache; Humans; Infant; Infant, Newborn; Male; MEDLINE; Mental Disorders; Middle Aged; Nausea; Paroxetine; Selective Serotonin Reuptake Inhibitors; Sensation Disorders; Sertraline; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Venlafaxine Hydrochloride

Compulsive buying has a long history. Described nearly a century ago by Kraepelin, and later by Bleuler, the disorder has been of interest to psychoanalysts and to the popular media. Recent interest has been rekindled by consumer behavior research that shows it to be widespread and psychiatric research that shows it to have the earmarks of a psychiatric disorder. The author reviews the history, definition, epidemiology, family history, etiology, clinical symptoms, and treatments of compulsive buying. Preliminary data from an open-label study in which subjects received fluvoxamine are also presented.

Topics: Adult; Age of Onset; Comorbidity; Compulsive Behavior; Disruptive, Impulse Control, and Conduct Disorders; Female; Fluvoxamine; Humans; Male; Mental Disorders; Sex Factors; Treatment Outcome

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

This study investigated effects of the 3435 C>T genotype of the adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1, MDR1) gene on the steady-state plasma concentration of fluvoxamine (FLV).. Sixty-two psychiatric patients were treated with different doses (50, 100, 150, and 200 mg/d) of FLV. Blood samples were collected after at least 2 weeks of treatment with the same daily dose to obtain steady-state concentrations of FLV, and 3435 C>T genotype was determined by polymerase chain reaction.. FLV concentration-to-dose ratio was significantly different among 3435 C>T genotype groups at the 200 mg/d dose (P = 0.019). A post-hoc analysis revealed that FLV concentration-to-dose ratio was significantly higher in the TT genotype group as compared with the CC genotype group at the 200 mg/d dose (median value of concentration-to-dose ratio (ng/mL)/(mg/d), 0.861 vs 0.434, P = 0.026). FLV concentration-to-dose ratio was significantly higher in the CT + TT genotype group than the CC genotype group at the 200 mg/d dose (median value of concentration-to-dose ratio (ng/mL)/(mg/d), 0.618 vs 0.434, P = 0.031). At 50, 100, and 150 mg/d dose, FLV concentration-to-dose ratios were not significantly different among 3435 C>T genotype groups. At 50, 100, and 150 mg/d dose, no significant differences were found in FLV concentration-to-dose ratios between the CT + TT genotype group and CC genotype group.. This study suggests that pharmacokinetics of FLV depend on ABCB1 gene polymorphism only at the 200 mg/d dose.

Topics: Adult; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Dose-Response Relationship, Drug; Female; Fluvoxamine; Genotype; Humans; Male; Mental Disorders; Organic Anion Transporters; Polymorphism, Single Nucleotide; Selective Serotonin Reuptake Inhibitors

Administration of fluvoxamine (FLV) with concomitant benzodiazepines is common in clinical situations. We studied the effects of the coadministration of FLV on plasma concentrations of alprazolam (ALP). We also studied the effects of CYP2C19(*)2 or CYP2C19(*)3 on these drug interactions.. The subjects were 23 Japanese outpatients all concomitantly treated with FLV either before or after monotherapy with ALP. We measured the plasma concentrations of ALP and FLV using a column-switching, high-performance liquid chromatographic method with ultraviolet detection. The CYP2C19(*)2 or CYP2C19(*)3 alleles were identified using a polymerase chain reaction analysis.. Coadministration with FLV produced significant, on average 58%, increases in the plasma concentrations of ALP ( P<0.001). There were, however, wide variations in the interactive effects of the coadministration of FLV on the plasma concentrations of ALP. While there were some subjects who had greater increases in plasma ALP concentrations, more than 100%, in response to the coadministration of FLV among the subjects with no mutated or one mutated allele, there are no subjects who had increases in plasma ALP concentrations of more than 50% among the subjects with two mutated alleles. The differences of these variances among the three genotype groups reached a level of significance ( P<0.05).. Coadministration of FLV significantly increased the plasma concentrations of ALP compared with ALP monotherapy. Wide variations were observed in the drug interactions, with the CYP2C19 genotype possibly being related to these interactions.

Topics: Adult; Alleles; Alprazolam; Anti-Anxiety Agents; Aryl Hydrocarbon Hydroxylases; Cytochrome P-450 CYP2C19; Drug Interactions; Female; Fluvoxamine; Genotype; Humans; Japan; Male; Mental Disorders; Middle Aged; Mixed Function Oxygenases; Mutation; Selective Serotonin Reuptake Inhibitors

A 10-week open-label trial of fluvoxamine was conducted for male Vietnam combat veterans with chronic PTSD. Subjects were excluded if they met full current criteria for panic disorder or agoraphobia, and lifetime criteria for psychosis, bipolar disorder, or organic mental syndrome. Repeated MANOVA was performed to determine change over time. Fluvoxamine was well tolerated; side effects were observed primarily early in treatment with headache, insomnia, sedation, and gastrointestinal distress being most frequent. Fluvoxamine was effective for treating the core intrusion, avoidance, and arousal symptoms of PTSD. Large treatment effects were seen by 4-6 weeks, and maintained at 10 weeks. The magnitude of change was greater than has been previously reported for antidepressant treatment of male Vietnam combat veterans with PTSD.

Topics: Ambulatory Care; Combat Disorders; Comorbidity; Depressive Disorder; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged; Psychiatric Status Rating Scales; Treatment Outcome; Veterans; Vietnam

To determine the efficacy and safety of a serotonin selective reuptake inhibitor (SSRI) combined with moclobemide in the treatment of 11 patients with various DSM-III-R diagnoses.. Subjects received moclobemide in doses of 150 to 800 mg/day together with sertraline (N = 5) in doses of 25 to 200 mg/day or fluvoxamine (N = 6) in doses of 50 to 200 mg/day. Patients were carefully monitored for side effects and for clinical response at the end of the trial, which lasted a minimum of 5 weeks.. The combination was tolerated extremely well. Insomnia was the most common side effect, occurring in 5 of 11 subjects. A marked or complete therapeutic response was noted in 8 of 11 subjects.. This open clinical trial suggests that combined SSRI-moclobemide treatment appears to be safe and well tolerated. It may also have therapeutic effects in treatment-refractory patients.

Topics: 1-Naphthylamine; Adult; Benzamides; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged; Moclobemide; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors; Sertraline

In order to evaluate serotonin (5-HT) function in panic disorder, a double blind placebo controlled study was conducted with ritanserin, a specific 5-HT2 receptor antagonist, and fluvoxamine, a selective 5-HT reuptake inhibitor, in 60 patients with panic disorder. Patients were treated for 8 weeks with 150 mg fluvoxamine, 20 mg ritanserin or placebo; these dose levels were reached after 1 week. In addition, as an index of 5-HT function in panic disorder, plasma concentration of beta-endorphin, cortisol and 5-hydroxyindolacetic-acid (5-HIAA) were measured. Furthermore, 5-HT uptake in blood platelets was assessed. Noradrenergic function was assessed by measuring plasma MHPG concentration. In addition, plasma melatonin concentration was measured. Treatment with fluvoxamine resulted in a profound reduction in the number of panic attacks, followed by a decrease in avoidance behavior. Treatment with ritanserin appeared to be ineffective. During treatment no significant changes were observed in plasma concentrations of beta-endorphin, cortisol, 5-HIAA and MHPG. With respect to 5-HT kinetics in blood platelets, a substantial increase in Km was observed after treatment with fluvoxamine, whereas Vmax decreased. After treatment with fluvoxamine, plasma concentration of melatonin was significantly increased, which suggests that melatonin synthesis is in part under serotonergic control. The findings of the present study do not support the hypothesis that 5-HT2 receptors are supersensitive in patients suffering from panic disorder, but allow no conclusions about the involvement of other 5-HT receptor subtypes.

Topics: Adult; beta-Endorphin; Blood Platelets; Double-Blind Method; Fear; Female; Fluvoxamine; Humans; Hydrocortisone; Hydroxyindoleacetic Acid; Male; Melatonin; Mental Disorders; Methoxyhydroxyphenylglycol; Norepinephrine; Oximes; Panic; Piperidines; Psychiatric Status Rating Scales; Randomized Controlled Trials as Topic; Ritanserin; Serotonin

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

The protein quality control mechanism in the endoplasmic reticulum is referred to as the unfolded protein response (UPR), and its failure may be involved in the onset of some psychiatric disorders. We showed that induction of the sigma-1 receptor plays a role in the UPR, and suggested the possibility that this mechanism is impaired in disorders such as schizophrenia. We also demonstrated that fluvoxamine induces expression of the sigma-1 receptor. Therefore, it has the potential to be developed as a drug which exerts an anti-ER-stress effect, i. e., protein quality control effect.

Topics: Animals; Endoplasmic Reticulum; Fluvoxamine; Humans; Mental Disorders; Protein Unfolding; Receptors, sigma; Sigma-1 Receptor; Signal Transduction

The aim of this study was to describe the frequency and trends in prescriptions and recommendations for selective serotonin reuptake inhibitors (SSRIs) for mental health disorders in children and adolescents in Canada from 2005 to 2009.. Data were extracted from databases supplied by IMS Brogan (IMS), a proprietary source of pharmacoepidemiologic data. Analyses were performed to obtain descriptive statistics on SSRI prescriptions dispensed, SSRI drug recommendation frequency, reasons for drug recommendations (therapeutic indication), and median duration of use of SSRIs in Canadian children. Canadian census data were used to assess whether changes in SSRI use were related to changes in the number of children in Canada over the time period studied.. SSRI prescriptions written by pediatricians increased by 39 %, while SSRI drug recommendations by all specialists for children and adolescents increased by 44 % over the 5-year interval. Over the 5-year period studied, fluoxetine was the most commonly recommended and dispensed SSRI. The use of escitalopram has increased while the use of paroxetine has declined. Between 2005 and 2009, the two most common therapeutic indications for SSRI recommendations were mood disorder (50 %) and anxiety disorder (25 %). Median treatment duration was less than 1 year, with duration generally increasing with patient age.. The increase in use of SSRIs in Canadian children and adolescents from 2005 to 2009 suggests that the effects of public health warnings concerning suicidal thinking and behavior associated with these drugs are now dissipating. This may be attributable to the FDA's pediatric approvals for fluoxetine and escitalopram, the growing comfort of clinicians with using SSRIs in children, limited availability of psychosocial treatments, and the influence of marketing. The use of paroxetine has continued to decline, likely because of specific warnings directed toward this agent and limited evidence supporting its efficacy.

Topics: Adolescent; Anti-Anxiety Agents; Antidepressive Agents; Canada; Child; Child, Preschool; Citalopram; Databases, Factual; Fluoxetine; Fluvoxamine; Humans; Infant; Mental Disorders; Paroxetine; Practice Patterns, Physicians'; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Aged, 80 and over; Alzheimer Disease; Amnesia; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Second-Generation; Celecoxib; Cyclooxygenase 2 Inhibitors; Female; Fluvoxamine; Humans; Mental Disorders; Phenylpropionates; Pyrazoles; Sulfonamides

Mental health workers in industry is a major health and social resource of any developed country. Unfortunately, Russia's level of mental health workers is unfavorable level. We have conducted a survey of employees psychoprophylactic mass of the gas industry, which occupies a leading position in the economy. Found that the prevalence of mental disorders in this professional group is 187 per 1,000 workers. In this case, 99.3% of employees with mental health problems of mentally ill for a long time, they do not receive appropriate treatment. Leading position in the structure occupy disorder with anxious and depressive symptoms, about 75% of all cases. In the treatment of these patients showed the highest efficiency Luvox, which is one of the most appropriate products in a production environment.

Topics: Adult; Antidepressive Agents, Second-Generation; Anxiety; Depression; Extraction and Processing Industry; Fluvoxamine; Humans; Mental Disorders; Mental Health; Middle Aged; Occupational Health; Russia; Workforce

The CYP2D6 enzyme is a capacity-limited high-affinity drug elimination pathway that metabolizes numerous psychiatric medicines. The capacity-limited nature of this enzyme suggests that drug dose may serve as an important factor that influence genotype-phenotype associations. However, dose dependency of CYP2D6 genotype contributions to drug elimination, and its interaction with environmental factors (e.g., smoking) did not receive adequate attention in translational study designs. Fluvoxamine is a selective serotonin reuptake inhibitor antidepressant. Fluvoxamine concentration is one of the factors previously linked to clinical remission in moderate to severe depression. We investigated the joint effect of smoking (an inducer of CYP1A2) and CYP2D6 genotype on interindividual variability in fluvoxamine steady-state concentration. Fluvoxamine concentration was measured in 87 patients treated with 50, 100, 150 or 200 mg/d. While CYP2D6 genotype significantly influenced fluvoxamine concentration in all four dose groups (p < 0.05), the percentage variance explained (R²) by CYP2D6 decreased as the dose of fluvoxamine increased. Smoking status (nonsmokers vs. smoking 20 or more cigarettes/d) significantly affected fluvoxamine concentration in the 50 mg/d group only (p = 0.005). Together, CYP2D6 genotype and smoking status explained 23% of the variance in fluvoxamine concentration but only at the low 50 mg/d dose group. These findings contribute to evidence-based and personalized choice of fluvoxamine dose using smoking status and CYP2D6 genetic variation. Additionally, these data lend evidence for drug dose as an important variable in translational pharmacogenetic study design and pharmaceutical phenotype associations with capacity-limited drug metabolism pathways such as CYP2D6.

Topics: Adult; Asian People; Chi-Square Distribution; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP2D6; Female; Fluvoxamine; Genetic Association Studies; Genotype; Humans; Japan; Male; Mental Disorders; Middle Aged; Mutation; Patient Selection; Pharmacogenetics; Phenotype; Regression Analysis; Selective Serotonin Reuptake Inhibitors; Smoking; Translational Research, Biomedical

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

Although there are reports on their use for the treatment of enuresis, we present three pediatric cases with serotonin-selective reuptake inhibitor (SSRI)-induced enuresis. Because SSRIs continue to be commonly prescribed in the pediatric population, the need to monitor for the possibility of enuresis precipitated by SSRIs is increasingly important.

Topics: Child; Citalopram; Female; Fluvoxamine; Humans; Male; Mental Disorders; Nocturnal Enuresis; Selective Serotonin Reuptake Inhibitors; Sertraline

A number of methods for analysing longitudinal ordinal categorical data with missing-at-random drop-outs are considered. Two are maximum-likelihood methods (MAXLIK) which employ marginal global odds ratios to model associations. The remainder use weighted or unweighted generalized estimating equations (GEE). Two of the GEE use Cholesky-decomposed standardized residuals to model the association structure, while another three extend methods developed for longitudinal binary data in which the association structures are modelled using either Gaussian estimation, multivariate normal estimating equations or conditional residuals. Simulated data sets were used to discover differences among the methods in terms of biases, variances and convergence rates when the association structure is misspecified. The methods were also applied to a real medical data set. Two of the GEE methods, referred to as Cond and ML-norm in this paper and by their originators, were found to have relatively good convergence rates and mean squared errors for all sample sizes (80, 120, 300) considered, and one more, referred to as MGEE in this paper and by its originators, worked fairly well for all but the smallest sample size, 80.

Topics: Biometry; Data Interpretation, Statistical; Fluvoxamine; Humans; Likelihood Functions; Longitudinal Studies; Mental Disorders; Models, Statistical; Odds Ratio; Selective Serotonin Reuptake Inhibitors

Administration of fluvoxamine with concomitant benzodiazepines is common in clinical situations. This study investigated the effects of the coadministration of fluvoxamine on plasma concentrations of etizolam and evaluated the effects of various fluvoxamine doses on drug interactions with etizolam. Subjects were 18 Japanese outpatients concomitantly treated with fluvoxamine before or after monotherapy with etizolam. Plasma concentrations of etizolam were measured using a column-switching high-performance liquid chromatographic method with ultraviolet detection. In 17 subjects treated concomitantly with fluvoxamine at 25 mg or 50 mg, the ranges of plasma concentrations of etizolam corrected for the dose increased from 2.0-13.3 (mean 6.3 +/- 3.6, n = 17) in monotherapy to 2.7-18.2 (mean 9.6 +/- 5.1, n = 17) ng/mL/mg in concomitant doses. Wide variations were observed in the drug interactions; however, coadministration with fluvoxamine produced significant changes in the plasma concentrations of etizolam (P < 0.0001) with a median of 42.9% (range 0.0 to 235.0%). Although the sleepiness of the subjects was evaluated using the Stanford Sleepiness Scale, no changes in sleepiness were found between the etizolam-monotherapy and the fluvoxamine-concomitant states. Of the 12 subjects treated concomitantly with fluvoxamine at 25 mg, 2 subjects received fluvoxamine at a dose increased up to 150 mg, and another received fluvoxamine at a dose increased up to 200 mg. They showed an increase in the plasma concentrations of etizolam in a fluvoxamine dose-dependent manner; more particularly, the increased dose of fluvoxamine (150 mg and 200 mg) resulted in about a twofold variation in plasma concentrations of etizolam.

Topics: Adult; Aged; Ambulatory Care; Asian People; Diazepam; Drug Interactions; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged

The authors examined the efficacy of a multifaceted intervention designed to contain the cost of prescribing selective serotonin reuptake inhibitors (SSRIs) to inpatients and outpatients served by a Veterans Affairs (VA) medical center.. Elements of the intervention included identification of a preferred agent, tablet splitting, education and feedback for prescribers, and an electronic record and ordering system to facilitate changes in prescriber behaviors. VA databases were searched for information on use and costs of antidepressants.. Over 35 months the number of patients treated with SSRIs and the amount spent on SSRIs increased. However, the mean monthly cost per patient decreased from $57.12 to $42.19. The projected cost savings over the 35 months was approximately $700,000; one-fourth of the savings was due to tablet splitting and three-fourths to changes in the proportions of the various SSRIs prescribed. A survey of the top 75 antidepressant prescribers showed that after the educational interventions, 91 percent were aware that citalopram was the medical center's preferred antidepressant, and 59 percent identified it as their own preferred first-line treatment.. The results suggest that multifaceted interventions can influence antidepressant costs through provider education and changes in pharmacy and computerized information processes, resulting in substantial cost savings for institutions.

Topics: Citalopram; Clinical Pharmacy Information Systems; Cost Control; Cost Savings; Drug Administration Schedule; Drug Costs; Drug Utilization; Fluoxetine; Fluvoxamine; Hospital Costs; Hospitals, Veterans; Humans; Mental Disorders; Paroxetine; Selective Serotonin Reuptake Inhibitors; Sertraline; United States

Serotonin transporters (5-HTT) are regarded as one of the major therapeutic targets of antidepressants. However, there have only been a few studies about 5-HTT occupancy, and in particular, data concerning classical antidepressants are still limited.. To investigate the relationship between 5-HTT occupancy and a wide range of antidepressant dosing protocols.. Antidepressant occupancies of 5-HTT were measured using positron emission tomography (PET) with [11C](+)McN5652. Twenty-seven healthy volunteers were measured with and without pretreatment with single low doses of antidepressants, and long-term doses were evaluated in 10 patients. Scan data were collected between December 12, 1995, and August 7, 2002, and data were analyzed during the 2001-2002 period at the National Institute of Radiological Sciences (Chiba, Japan). Intervention Four different doses of clomipramine hydrochloride (5-50 mg) and 3 different doses of fluvoxamine maleate (12.5-50 mg) were used for single administration. Long-term doses were 20 to 250 mg per day for clomipramine hydrochloride, and 25 to 200 mg per day for fluvoxamine maleate. Main Outcome Measure Occupancies in the thalamus were calculated using the individual baseline of [11C](+)McN5652 for single-dose studies and 2 long-term-dose studies, and the mean value of healthy volunteers as the baseline for 8 long-term-dose studies. The average data from inactive enantiomers [11C](-)McN5652 were used for the estimation of nonspecific binding.. Occupancy of 5-HTT increased in a curvilinear manner. Even 10 mg of clomipramine hydrochloride showed approximately 80% occupancy, which was comparable with that of 50 mg of fluvoxamine maleate. Estimated median effective dose (ED50) of clomipramine hydrochloride was 2.67 mg for oral dose and 1.42 ng/mL for plasma concentration; those of fluvoxamine maleate were 18.6 mg and 4.19 ng/mL, respectively.. Clinical doses of clomipramine and fluvoxamine occupied approximately 80% of 5-HTT, and dose escalation would have minimal effect on 5-HTT blockade. Ten milligrams of clomipramine hydrochloride was enough to occupy 80% of 5-HTT in vivo.

Topics: Adult; Antidepressive Agents, Tricyclic; Carrier Proteins; Clomipramine; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluvoxamine; Humans; Male; Membrane Glycoproteins; Membrane Transport Proteins; Mental Disorders; Middle Aged; Nerve Tissue Proteins; Selective Serotonin Reuptake Inhibitors; Serotonin Plasma Membrane Transport Proteins; Thalamus; Tomography, Emission-Computed

Topics: Adult; Antiemetics; Child; Chronic Disease; Disabled Persons; Feeding and Eating Disorders of Childhood; Fluvoxamine; Humans; Male; Mental Disorders; Selective Serotonin Reuptake Inhibitors; Vomiting

Topics: Adult; Aggression; Female; Fluvoxamine; Humans; Intellectual Disability; Male; Mental Disorders; Selective Serotonin Reuptake Inhibitors

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Humans; Incidence; Male; Mental Disorders; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological

Most models for incomplete data are formulated within the selection model framework. This paper studies similarities and differences of modeling incomplete data within both selection and pattern-mixture settings. The focus is on missing at random mechanisms and on categorical data. Point and interval estimation is discussed. A comparison of both approaches is done on side effects in a psychiatric study.

Topics: Biometry; Data Interpretation, Statistical; Female; Fluvoxamine; Humans; Likelihood Functions; Male; Mental Disorders; Models, Statistical; Selective Serotonin Reuptake Inhibitors

Topics: Adolescent; Adult; Child; Citalopram; Cytochrome P-450 Enzyme System; Drug Prescriptions; Fluoxetine; Fluvoxamine; Humans; Mental Disorders; Paroxetine; Selective Serotonin Reuptake Inhibitors; Sertraline

A clinical case is presented in which the use of a prescribed psychotropic medication was associated with dramatic changes in ethnoculturally determined attitudes and behavior. These changes were first noticed by the patient and followed a month of improvement in the target symptoms for which the medication was prescribed. The hypothesis is advanced that changes in identity may occur only after the establishment and adjustment to a new neurohormonal equilibrium. Medication-induced personality changes may facilitate changes in ethnocultural identity.

Topics: Adult; Culture; Fluvoxamine; Humans; Male; Mental Disorders; Psychotropic Drugs

A review was conducted of the safety and tolerability of fluvoxamine in 54 worldwide marketing studies that enrolled 24,624 patients, the majority of whom were treated with fluvoxamine in uncontrolled studies in depression. In accordance with the general epidemiologic distribution of depressive disorder, female patients and patients aged between 30 and 50 years predominated. The majority of patients were treated for 6 weeks, the most frequent, or modal, total daily dose being 100 mg. Overall, 57.4% of the patients exposed to fluvoxamine did not have any adverse experiences. The greatest proportion of adverse experiences, as defined using COSTART body systems, affected the digestive system (24.1%), the nervous system (23.7%), and the body as a whole (15.3%). The only adverse experience with an incidence greater than 10% was nausea (15.7%); somnolence (6.9%) and asthenia (6.2%) were the next most frequent adverse experiences. Notably, the rates of agitation and anxiety were only 1.4% and 1.3%, respectively. The incidences of adverse experiences generally increased with age and were slightly higher in females than in males. In total, 15.1% of patients discontinued treatment prematurely as a result of adverse experiences, principally nausea, dizziness, vomiting, somnolence, abdominal pain, and headache. The overall incidence of serious adverse events in association with fluvoxamine treatment was 2.5% when U.S. Food and Drug Administration criteria and the most conservative approach, without causality judgments, were used.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Databases, Factual; Depression; Europe; Female; Fluvoxamine; Humans; Male; Mental Disorders; Middle Aged; Product Surveillance, Postmarketing; Suicide

Topics: Adult; Basal Ganglia Diseases; Female; Fluoxetine; Fluvoxamine; Humans; Mental Disorders; Middle Aged; Movement; Oximes; Serotonin Antagonists