fluvoxamine and Stress-Disorders--Post-Traumatic

Sleep disturbances are among the most commonly endorsed symptoms of post-traumatic stress disorder (PTSD). Treatment modalities that are effective for the waking symptoms of PTSD may have limited efficacy for post-traumatic sleep problems. The aim of this review is to summarize the evidence for empirically supported and/or utilized psychotherapeutic and pharmacological treatments for post-traumatic nightmares and insomnia. While there are few controlled studies of the applicability of general sleep-focused interventions to the management of the sleep disturbances in PTSD, evidence is growing to support several psychotherapeutic and pharmacological treatments. Future investigations should include trials that combine treatments focused on sleep with treatments effective in managing the waking symptoms of PTSD.

Topics: Antipsychotic Agents; Cognitive Behavioral Therapy; Dreams; Eye Movement Desensitization Reprocessing; Fluvoxamine; Humans; Piperazines; Prazosin; REM Sleep Behavior Disorder; Restless Legs Syndrome; Serotonin and Noradrenaline Reuptake Inhibitors; Sleep; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Stress Disorders, Post-Traumatic; Trazodone; Triazoles

Fluvoxamine is a potent and selective serotonin reuptake inhibitor (SSRI) that has little or no effect on other monoamine reuptake mechanisms. Relative to other SSRIs, fluvoxamine is a weak inhibitor of cytochrome P450 (CYP) 2D6, a moderate inhibitor of CYP2C19 and CYP3A4 and a potent inhibitor of CYP1A2. In randomised, double-blind trials. fluvoxamine 100 to 300 mg/day for 6 to 10 weeks significantly reduced symptoms of obsessive-compulsive disorder (OCD) compared with placebo. Response rates of 38 to 52% have been reported with fluvoxamine, compared with response rates of 0 to 18% with placebo. In patients with OCD, fluvoxamine had similar efficacy to that of clomipramine and, in smaller trials, the SSRIs paroxetine and citalopram and was significantly more effective than desipramine. Maintenance therapy with fluvoxamine may reduce the likelihood of relapses in up to 67% of patients with OCD. Fluvoxamine < or = 300 mg/day for 6 to 8 weeks was as effective as imipramine in patients with panic disorder, and significantly more effective than placebo. In addition, treatment with fluvoxamine < or = 300 mg/day for > or = 8 weeks improved symptoms of social phobia (social anxiety disorder), post-traumatic stress disorder (PTSD), pathological gambling, compulsive buying, trichotillomania, kleptomania, body dysmorphic disorder, eating disorders and autistic disorder. Large trials comparing the efficacy of fluvoxamine and other SSRIs in patients with anxiety disorders are warranted. Fluvoxamine is generally well tolerated; in postmarketing studies, nausea was the only adverse event occurring in >10% of patients with less commonly reported events including somnolence, asthenia, headache, dry mouth and insomnia. Fluvoxamine is associated with a low risk of suicidal behaviour, sexual dysfunction and withdrawal syndrome. Fewer anticholinergic or cardiovascular events are associated with fluvoxamine than tricyclic antidepressants. Although comparative data are lacking, the tolerability profile of fluvoxamine appears to be broadly similar to those of other SSRIs.. Fluvoxamine has demonstrated short term efficacy in the treatment of OCD, panic disorder, social phobia, PTSD and in a range of obsessive-compulsive spectrum disorders. The drug is as effective as clomipramine in patients with OCD but appears to have a better tolerability profile. On the basis of current treatment guidelines, fluvoxamine, like other SSRIs, is recommended as first-line treatment for a number of anxiety disorders. It appears to offer some pharmacokinetic advantages and a different drug interaction profile to the other SSRIs with a broadly similar spectrum of adverse events. However, direct comparisons are required to assess the relative efficacy and tolerability of the different agents of this drug class.

Topics: Adult; Aged; Drug Interactions; Feeding and Eating Disorders; Fluvoxamine; Humans; Intestinal Absorption; Metabolic Clearance Rate; Obsessive-Compulsive Disorder; Panic Disorder; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic

Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms.. We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive-compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106). In all 3 data sets, we examined whether a measure of variability in symptoms occurring during the first sessions could predict sudden gains.. Variability in symptoms was found to be independent of total change during treatment. Variability in symptoms significantly predicted sudden gains in all 3 data sets and correctly classified 81.0%, 69.2%, and 76.9% of individuals to sudden gain or nonsudden gain status, respectively.. The present study represents the first examination of variability in symptoms as a predictor of sudden gains. Findings indicated that sudden gains are significantly predicted by intraindividual variability in symptoms, in diverse settings, contexts, and populations. Advantages of this predictor, as well as clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Topics: Adaptation, Psychological; Adolescent; Adult; Child; Cognitive Behavioral Therapy; Combined Modality Therapy; Female; Fluvoxamine; Humans; Implosive Therapy; Individuality; Male; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Psychotherapy, Psychodynamic; Stress Disorders, Post-Traumatic; Treatment Outcome; Young Adult

Motor vehicle accidents (MVAs) are a leading cause of posttraumatic stress disorder (PTSD) in the general population. Alterations in norepinephrine and serotonin systems have been proposed as mechanisms involved in the pathophysiology of the condition, with treatment directed at these neurotransmitter systems. Reboxetine, a selective norepinephrine reuptake inhibitor, exhibits high affinity and selectivity for the human norepinephrine transporter. Inasmuch as PTSD may be associated with dysregulation of noradrenergic activity, the present double-blind randomized clinical trial intended to evaluate reboxetine's efficacy in the management of MVA-related PTSD and to compare its efficacy with a medication commonly used in PTSD, the selective serotonin reuptake inhibitor fluvoxamine.. Forty patients with MVA-related PTSD attending a local community mental health outpatient clinic were randomized to receive a fixed dose of either reboxetine (8 mg/d) or fluvoxamine (150 mg/d) in a double-blind fashion for a period of 8 weeks.. At baseline and at study end point, the 2 subgroups demonstrated no statistical differences in scores on PTSD, depression, and anxiety rating scales. Both medications led to significant improvements in all clinical scales measured. Nine patients receiving reboxetine and 3 receiving fluvoxamine withdrew from the study because of side effects.. Study observations indicate comparable efficacy of reboxetine and fluvoxamine in the management of MVA-related PTSD despite reboxetine's selective noradrenergic activity. Reboxetine appears to be at least as effective as fluvoxamine and may offer an alternative management option in this often difficult-to-treat and disabling condition. A lower and flexible reboxetine dosing schedule will be recommended for future research to improve its tolerability in PTSD patients.

Topics: Accidents, Traffic; Adult; Ambulatory Care Facilities; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Double-Blind Method; Female; Fluvoxamine; Humans; Israel; Male; Morpholines; Psychiatric Status Rating Scales; Reboxetine; Stress Disorders, Post-Traumatic; Treatment Outcome

The aim of the study is to test whether fluvoxamine affects the function of the hypothalamic pituitary adrenal (HPA) axis in female borderline (borderline personality disorder, BPD) patients with and without a history of sustained childhood abuse. Special attention is given to the presence of comorbid major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The HPA axis of 30 female BPD patients with (n = 17) and without (n = 13) a history of sustained childhood abuse was challenged with a combined dexamethasone and corticotropin releasing hormone test (DEX/CRH test) before and after 6 (n = 14) and 12 (n = 16) weeks of fluvoxamine treatment (150 mg/day). Both 6- and 12-week fluvoxamine treatments were associated with a significant and robust reduction of the adrenocorticotrophic hormone (ACTH) and cortisol response to the DEX/CRH test. The magnitude of the reduction was dependent on the presence of sustained childhood abuse, but not on the presence of comorbid MDD or PTSD: patients with a history of sustained childhood abuse showed the strongest reduction in ACTH and cortisol. In conclusion, Fluvoxamine treatment reduces the hyperresponsiveness of the HPA axis in BPD patients with a history of sustained childhood abuse. This effect is likely to be obtained in the first 6 weeks of treatment.

Topics: Adult; Antidepressive Agents, Second-Generation; Area Under Curve; Borderline Personality Disorder; Child; Child Abuse; Corticotropin-Releasing Hormone; Depressive Disorder; Dexamethasone; Female; Fluvoxamine; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic

This study was designed to investigate the efficacy of the antidepressant fluvoxamine in the treatment of combat-related post-traumatic stress disorder (PTSD). Fifteen veterans with combat-related PTSD and no other psychiatric diagnosis except depression were recruited to participate in a 14-week open-label study of fluvoxamine. Patients underwent a 30-day washout period and were rated with the Clinician Administered PTSD Scale (CAPS), Mississippi Scale, Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) at baseline, and every 2 weeks until week 14. Three patients stopped fluvoxamine prematurely due to side effects and 7 withdrew consent before completing the 14-week trial. Eight patients completed at least 8 weeks of treatment. The total daily dose of fluvoxamine ranged from 100 to 300 mg with a mean daily dose of 150 mg at week 14. Intent-to-treat analysis revealed a significant improvement in total CAPS scores, and in the intrusion and the avoidance/numbing subscales. The CAPS hyper-arousal scores did not change significantly. HAM-A score also improved significantly. No significant changes were seen on the Mississippi scale, HAM-D, or Beck Depression Inventory in the intent-to-treat analysis. In summary, our study shows that fluvoxamine appears to improve combat-related PTSD symptoms but not depressive symptoms. The high attrition rate and lack of a placebo group limits the conclusions of our study. Controlled studies of fluvoxamine in the treatment of PTSD are warranted.

Topics: Depression; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Stress Disorders, Post-Traumatic; Time Factors; Veterans

This study assesses the efficacy of fluvoxamine treatment on different domains of subjective sleep quality in Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD). Medically healthy male Vietnam theater combat veterans (N = 21) completed a 10-week open label trial. Fluvoxamine treatment led to improvements in PTSD symptoms and all domains of subjective sleep quality. The largest effect was for dreams linked to the traumatic experience in combat. In contrast, generic unpleasant dreams showed only a modest response to treatment. Sleep maintenance insomnia and the item "troubled sleep" showed a large treatment response, whereas sleep onset insomnia improved less substantially. These therapeutic benefits contrast with published reports that have found activating effects of Selective Serotonin Reuptake Inhibitors on the sleep electroencephalogram.

Topics: Adult; Aged; Fluvoxamine; Humans; Male; Middle Aged; Personality Disorders; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Stress Disorders, Post-Traumatic; Treatment Outcome

This study assessed the effect of open-label fluvoxamine treatment for posttraumatic stress disorder (PTSD), depressive symptoms, and physiologic arousal to trauma cues. Baseline psychometric ratings and physiologic assessments of heart rate and blood pressure responses to individualized, taped trauma scripts were determined for 16 patients with PTSD and 16 mentally healthy age- and gender-matched control subjects exposed to at least 1 serious trauma. Patients with PTSD had greater autonomic reactivity than control subjects at baseline, with physiologic measures correlating with the severity of the PTSD for the combined groups. Discriminant analyses indicated that systolic blood pressure best classified patients with PTSD (75% sensitivity) and control subjects (100% specificity), with a stepwise discriminant analysis showing that combined physiologic variables correctly classified 75% of patients with PTSD and 100% of control subjects. After 10 weeks of fluvoxamine treatment (100-300 mg/day), patients' PTSD, depression, and physiologic reactivity improved significantly. Medicated patients with PTSD could not be distinguished statistically from untreated control subjects in any physiologic measure. This dampening of autonomic reactivity after drug treatment corroborates subjective measures of improvement, validating the reported efficacy of fluvoxamine in this open trial.

Topics: Adult; Anti-Anxiety Agents; Female; Fluvoxamine; Humans; Male; Psychiatric Status Rating Scales; Psychometrics; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic

The Davidson Trauma Scale (DTS) is a validated 17-item self-rating scale used in the diagnosis of post-traumatic stress disorder (PTSD), which is sensitive to the effects of treatment. It was felt that a shorter version of the scale might provide a better diagnostic screening tool. Subjects were drawn from a sample of 243 patients obtained from multiple cohorts that included a group of survivors of various forms of trauma, including natural disaster, rape and combat. All subjects had diagnostic assessments for PTSD with a clinical interview and completed the DTS. The data were randomly divided between two subsamples, and frequency and severity scores were calculated for the DTS. A four-item scale, the SPAN (named for its top four items: Startle, Physiological arousal, Anger, and Numbness), was developed. It demonstrated an efficiency of 0.88, sensitivity of 0.84, specificity of 0.91 and positive likelihood ratio of 9.1. In a replication sample, values were slightly lower but still acceptable (efficiency = 0.80). A subgroup of PTSD patients received either fluoxetine or placebo in a clinical trial, and a significant SPAN score improvement was observed on fluoxetine. The SPAN, which correlated significantly with the Impact of Events Scale, the Sheehan Disability Scale, and the Structured Interview of PTSD, was found to have a diagnostic accuracy of 88%.

Topics: Adult; Antidepressive Agents; Cohort Studies; Combat Disorders; Disasters; Female; Fluoxetine; Fluvoxamine; Humans; Lamotrigine; Male; Middle Aged; Personality Inventory; Piperazines; Psychometrics; Rape; Reproducibility of Results; Stress Disorders, Post-Traumatic; Triazines; Triazoles

Topics: Adolescent; Adult; Aged; Antidepressive Agents, Second-Generation; Female; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic

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

Childhood maltreatment is associated with impaired adult brain function, particularly in the hippocampus, and is not only a major risk factor for some psychiatric diseases but also affects early social development and social adaptation in later life. The aims of this study were to determine whether early postnatal stress affects social behavior and whether repeated fluvoxamine treatment reverses these changes. Rat pups were exposed to footshock stress during postnatal days 21-25 (at 3 weeks old: 3wFS). During the post-adolescent period (10-14 weeks postnatal), the social interaction test and Golgi-cox staining of dorsal hippocampal pyramidal neurons were performed. Following exposure to footshock stress, 3wFS rats showed an increase in social interaction time, which might be practically synonymous with hypersociability, and a decrease in spine density in the CA3 hippocampal subregion, but not in CA1. These behavioral and morphological changes were both recovered by repeated oral administration of fluvoxamine at a dose of 10 mg/kg/day for 14 days. These findings suggest that the vulnerability of the hippocampal CA3 region is closely related to social impairments induced by physical stress during the juvenile period and shed some light on therapeutic alternatives for early postnatal stress-induced emotional dysfunction.

Topics: Administration, Oral; Animals; Disease Models, Animal; Fluvoxamine; Hippocampus; Humans; Male; Rats, Wistar; Selective Serotonin Reuptake Inhibitors; Social Behavior Disorders; Stress Disorders, Post-Traumatic; Stress, Physiological

Topics: Adult; Chemical and Drug Induced Liver Injury; Citalopram; Depressive Disorder; Female; Fluvoxamine; Hepatorenal Syndrome; Humans; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic

Topics: Adult; Desensitization, Psychologic; Ephedra; Eye Movements; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Phytotherapy; Plant Preparations; Recurrence; Selective Serotonin Reuptake Inhibitors; Stress Disorders, Post-Traumatic; Weight Loss

Topics: Adult; Creatine Kinase; Depressive Disorder, Major; Dose-Response Relationship, Drug; Drug Administration Schedule; Fluvoxamine; Humans; Male; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Stress Disorders, Post-Traumatic

Topics: Adult; Drug Evaluation; Fluoxetine; Fluvoxamine; Humans; Male; Serotonin; Stress Disorders, Post-Traumatic; Veterans