Article

Tolerability and safety of fluvoxamine and other antidepressants

Department of Psychiatry,University Medical Centre, Utrecht, The Netherlands.
International Journal of Clinical Practice (Impact Factor: 2.54). 05/2006; 60(4):482-91. DOI: 10.1111/j.1368-5031.2006.00865.x
Source: PubMed

ABSTRACT Selective serotonin [5-hydroxytryptamine (5-HT)] reuptake inhibitors (SSRIs) and the 5-HT noradrenaline reuptake inhibitor, venlafaxine, are mainstays in treatment for depression. The highly specific actions of SSRIs of enhancing serotonergic neurotransmission appears to explain their benefit, while lack of direct actions on other neurotransmitter systems is responsible for their superior safety profile compared with tricyclic antidepressants. Although SSRIs (and venlafaxine) have similar adverse effects, certain differences are emerging. Fluvoxamine may have fewer effects on sexual dysfunction and sleep pattern. SSRIs have a cardiovascular safety profile superior to that of tricyclic antidepressants for patients with cardiovascular disease; fluvoxamine is safe in patients with cardiovascular disease and in the elderly. A discontinuation syndrome may develop upon abrupt SSRI cessation. SSRIs are more tolerable than tricyclic antidepressants in overdose, and there is no conclusive evidence to suggest that they are associated with an increased risk of suicide. Although the literature suggests that there are no clinically significant differences in efficacy amongst SSRIs, treatment decisions need to be based on considerations such as patient acceptability, response history and toxicity.

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    • "As many as 42% of adults over age 50 seemingly interrupted treatment after just one prescription. Discontinuation can be due to lack of medical effect of the drug (Beyer, 2007) or side effects (Westenberg et al., 2006). Nevertheless, evidence-based research suggest that treatment with a single antidepressant or combination of antidepressants, cognitive behavioral therapy, other types of psychotherapy, and electroconvulsive therapy can reduce depressive symptoms in older adults (Charney et al., 2003; Steinman et al., 2007). "
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    ABSTRACT: As many as 47% of adults over age 50 discontinue treatment with antidepressants after redeeming only one prescription. The study aim was to assess the risk of suicide in adults aged 50+ who discontinue antidepressants at an early stage of treatment. Case control study of all individuals aged 50+ living in Denmark and who initiated antidepressant treatment between July 1st 1995 and December 31st 2000 (N=217,123). Hazard ratios were calculated using Cox regression analyses, propensity score matching techniques, and marginal structural models. During the study period, 78,594 men and 138,529 women aged 50+ began treatment with an antidepressant medication, of whom 309 men and 229 women died by suicide. Men aged 50+ who discontinued treatment early had a suicide rate of 167 per 100,000 compared with 175 per 100,000 in those who continued refilling prescriptions; hazard ratio=0.98 [CI-95%: 0.78-1.23]. The suicide rate in women who discontinued treatment was 52 per 100,000 compared with 74 per 100,000 in those who continued refilling; hazard ratio=0.72 [CI-95%: 0.55-0.94]. Although people with previous psychiatric hospitalizations had greater risk of suicide than those without past hospital admissions, the difference was not significant in the adjusted model. Prescriptions redeemed at pharmacies are our only indicator of treatment adherence. Also, information on severity of depression was not available. We did not find a lower suicide risk among people over age 50 who seemingly follow treatment in comparison with those who discontinued treatment with antidepressants at an early stage.
    Journal of Affective Disorders 05/2009; 119(1-3):194-9. DOI:10.1016/j.jad.2009.03.011 · 3.71 Impact Factor
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    • "The SSRIs are preferred in the treatment of AD because of greater safety and tolerability an to date are licensed for the treatment of several AD including panic disorder (PD), GAD, obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) (Vaswani et al 2003). However, despite their favorable profi le of side effects, these drugs may cause some adverse effects that may be problematic for some patients such as sexual dysfunction, risk of bleeding, hyponatremia, discontinuation symptoms, and increased bodyweight (Westenberg and Sandner, 2006; Williams et al 2006). In fact, it has been reported that patients with AD are more sensible to side effects of psychopharmacological treatment (Bandelow et al 2006). "
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    ABSTRACT: Anxiety disorders (ADs) are the most common type of psychiatric disorders, with a mean incidence of 18.1% and a lifetime prevalence of 28.8%. Pharmacologic options studied for treating ADs may include benzodiazepines, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic drug (NaSSA) and dual-reuptake inhibitors of serotonin and norepinephrine (SNRIs). In this context, the development of SNRIs (venlafaxine and duloxetine) has been particularly useful. As a dual-acting intervention that targets two neurotransmitter systems, these medications would appePar promising for the treatment of ADs. The purpose of this review was to elucidate current facts and views about the role of duloxetine in the treatment of ADs. In February 2007, duloxetine was approved by FDA for the treatment of generalized anxiety disorder (GAD). The results of trials evaluating the use duloxetine in the treatment of GAD are supportive on its efficacy even if further studies on long-term use are needed. Apart from some interesting case reports, no large studies are, to date, present in literature about duloxetine and other ADs such as panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Therefore, the clinical efficacy and the relative good tolerability of duloxetine may be further investigated to widen the therapeutic spectrum of ADs.
    Neuropsychiatric Disease and Treatment 11/2008; 4(5):929-35. · 2.15 Impact Factor
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    • "Os eventos relativos à disfunção sexual foram de pequena monta (2,5% dos pacientes). Embora esses efeitos não tenham sido pesquisados de forma sistemática por meio de questionário específico neste estudo, é importante ressaltar que a baixa ocorrência de efeitos colaterais, no que tange à atividade sexual, tem sido apontada pela literatura corrente (Westenberg e Sandner, 2006; Buchberger e Wagner, 2002). Os eventos adversos foram, em sua maioria, transitórios e de pequena intensidade, diminuindo a partir da 2 a semana . "
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    ABSTRACT: OBJECTIVE: This research studied the efficacy and tolerability of fluvoxamine in the treatment of major depressive disorder (MDD), during 6 weeks, in an open trial, without placebo or active comparator. A secondary objective was the evaluation of the effects of fluvoxamine on the sleep of the pacients. METHODS: 104 patients were inicially included, with the diagnosis of MDD in accordance to the criteria of the Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV). Patients should have scores > 17 in the Hamilton Depression Scale for Depression 17 itens (HAM-D 17). The efficacy of fluvoxamine was studied through the HAM-D 17 and CGI (Clinical Global Impression). The analysis of the HAM-D 17 itens 4, 5, and 6 was used for the evaluation of the quality of sleep of the patients. Security and tolerability of fluvoxamine was assessed throughout the six weeks, being registered any adverse event. Fluvoxamine was inicially administered at the doses of 50 or 100 mg/day; the doses could be progressively increased until 300 mg/day. RESULTS: From the 104 included patients, 81 (78%) concluded the study. Sixty nine percent (69%) of the patients obtained favorable response (defined as 50% improvement in the HAM-D 17) and the remission rate (HAM-D 17 < 7) was 52%. The specific analysis of CGI showed significant improvement (p < 0.001) comparing to the baseline scores. The speficic analysis of the sleep itens of the HAM-D 17 showed significant improvement from the 2nd week; the improvement was sustained until the end of the 6 weeks study. The adverse events were those expected for the serotonin selective reuptake inhibitors (SSRI), predominantly gastrointestinal complaints, transitory and of low intensity in most of the cases. CONCLUSION: This study confirms the efficacy and tolerability of fluvoxamine in the treatment of MDD, and also its efficacy in the treatment of sleep disturbs among depressed patients. The profile of adverse events were those expected for SSRI. It should be emphasized that few patients reported sexual disfunction (2.5% of the patients).
    Jornal brasileiro de psiquiatria 12/2006; 56(1):17-22.
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