Schneiderian first-rank symptoms associated with fluvoxamine treatment: a case report

This communication describes a patient who developed Schneiderian first-rank symptoms in the course of treatment with fluvoxamine. The patient, a 28-year-old man suffering from panic disorder, developed several first-rank symptoms during fluvoxamine administration. These symptoms abated 1 week after fluvoxamine treatment was discontinued and haloperidol was started. Although haloperidol was discontinued, no further hallucinations or delusions occurred. This finding suggests that fluvoxamine can precipitate Schneiderian first-rank symptoms in some susceptible patients.     

Fluvoxamine augmentation in risperidone-resistant schizophrenia: an open trial

We investigated the efficacy and safety of augmenting risperidone with fluvoxamine for the treatment of residual positive and negative symptoms in patients with chronic schizophrenia who had shown an incomplete response to risperidone. A total of 30 patients completed the open trial over a 12-week period during which fluvoxamine was added to risperidone. The result from the positive and negative syndrome scale (PANSS) and Simpson-Angus extrapyramidal effects (S-A) scale were examined at baseline, 1, 2, 4, 8 and 12 weeks of treatment. There were no significant differences in PANSS positive, negative and general psychopathology scores, or in S-A scale scores at any point during the treatment. These results suggest that fluvoxamine appears to be ineffective in augmenting the risperidone treatment response in chronic schizophrenic patients. Further controlled trials will be needed to confirm this observation.     

Treatment strategy in depression. I. Non-tricyclic and selective reuptake inhibitors in resistant depression: a double-blind partial crossover study on the effects of oxaprotiline and fluvoxamine

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.     

Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 2-year naturalistic follow-up

Two years after completion of a controlled outcome study of treatments for panic disorder with agoraphobia, patients were revisited and interviewed about their complaints. In the initial study, four treatments had been compared: (i) fluvoxamine combined with exposure; (ii) placebo medication plus exposure; (iii) psychological panic management plus exposure; and (iv) exposure alone. Comparison of the results at post-test had revealed superior efficacy of fluvoxamine combined with exposure over the other three treatments in reducing agoraphobic avoidance. The current naturalistic follow-up study investigated the long-term efficacy of the treatments with regard to abatement of complaints and reduced demand for further treatment. In addition, we examined whether patients were able to taper off the study medication without a recurrence of complaints. In total, 71 of the 76 patients of the original trial (93%) were interviewed. Comparison of the mean level of psychopathology at follow-up revealed no difference between the original treatment groups. The effect in the fluvoxamine plus exposure group was maintained, but was no longer superior, due to further improvements in the other treatment groups. Most patients received additional treatment during the follow-up period, usually because the 12 treatment sessions in the controlled study had yielded insufficient improvement. There was a trend for patients who received the fluvoxamine plus exposure treatment to require less aftercare than those who received the other treatments. Finally, almost 50% of the patients who had received medication in the original trial were able to taper off the use of fluvoxamine without a recurrence of complaints.     

氟伏沙明与帕罗西汀治疗强迫症对照研究

目的探讨氟伏沙明与帕罗西汀治疗强迫症的临床疗效及安全性。方法将56例强迫症患者随机分为研究组和对照组各28例,分别给予氟伏沙明、帕罗西汀治疗。观察8周。于治疗前及治疗4周、8周末采用Yale-Brown强迫量表,副反应量表评定临床疗效和不良反应。结果治疗后两组Yale-Brown强迫量表评分均较治疗前有显著下降（P〈0．01）;治疗8周末研究组有效率为75％,对照组为78．5％,两组差异无显著性（P〉0．05）;两组不良反应均轻微,发生率无显著性差（P〉0．05）。结论氟伏沙明治疗强迫症疗效显著,与帕罗西汀相当,安全性高,依从性好。     

Selective serotonin reuptake inhibitors and withdrawal symptoms: a review of the literature

There are accumulating reports of withdrawal symptoms emerging following the discontinuation of selective serotonin reuptake inhibitor antidepressants. This report summarizes published reports, characterizes the withdrawal syndrome, discusses potential mechanisms of withdrawal, and makes recommendations for prevention and management. A computerized search was conducted using MEDLINE (1985–1996) to retrieve all case reports and pertinent studies of antidepressant withdrawal. A total of 46 case reports and two drug discontinuation studies were retrieved. All of the selective serotonin reuptake inhibitors were implicated in withdrawal reactions with paroxetine most often cited in case reports. Withdrawal reactions were characterized most commonly by dizziness, fatigue/weakness, nausea, headache, myalgias and paresthesias. The occurrence of withdrawal did not appear to be related to dose or treatment duration. Symptoms generally appeared 1–4 days after drug discontinuation, and persisted for up to 25 days. Time of onset and duration of symptoms differed little among the agents. The pathophysiology/pharmacology of withdrawal is unclear but may involve multiple neurotransmitter systems. It is concluded that all of the SSRIs can produce withdrawal symptoms and if discontinued, they should be tapered over 1–2 weeks to minimize this possibility. Some patients may require a more extended tapering period. No specific treatment for severe withdrawal symptoms is recommended beyond reinstitution of the antidepressant with subsequent gradual tapering as tolerated. © 1997 John Wiley & Sons, Ltd.