Fluvoxamine versus fluoxetine in major depressive episode: a double-blind randomised comparison

A double-blind, multinational study was conducted to compare the efficacy and safety of fluvoxamine and fluoxetine in outpatients with major depressive episode; 184 patients were randomised to fluvoxamine (100 mg/day) or fluoxetine (20 mg/day) for 6 weeks. Both drugs were effective and there were no statistically significant differences between them in the area under the curve of change from baseline in the Hamilton depression rating scale (HAMD) total score. However, the percentage of HAMD responders (>or= 50% decrease in HAMD total score) at week 2, the clinical global improvement severity of illness score at week 2 and the depression subscale of the irritability, depression and anxiety scale at weeks 1, 2 and 4, all showed significant advantages for fluvoxamine. During the last 2 weeks, fluvoxamine was significantly more effective in improving the HAMD sleep disturbance scale. Both drugs were well tolerated and there were no marked differences in their side effect profiles which were typical of SSRIs. Fluvoxamine and fluoxetine have similar efficacy and safety profiles in the treatment of major depressive episode; the findings of this study indicate that fluvoxamine may have a faster onset of action with respect to resolution of depressive symptoms and result in a better improvement in sleep quality.     

In vivo inhibition of CYP2C19 but not CYP2D6 by fluvoxamine

Studies were performed in eight healthy extensive metabolizers of mephenytoin and debrisoquine to determine the effect of fluvoxamine on the activities of S-mephenytoin 4'-hydroxylase (CYP2C19) and metoprolol α-hydroxylase (CYP2D6). Therapeutic dosing with fluvoxamine (100  mg day⁻¹) for 2 weeks caused a significant increase in the 0–8  h urinary S/R ratio of mephenytoin from 0.16 to 0.55 (95% confidence interval for difference between means: 0.28–0.50; P <0.01), accompanied by a 54% reduction in the 0–8  h urinary recovery of 4'-hydroxymephenytoin (95% confidence interval for difference between means: 3.64–16.24  mg; P <0.05). However, this did not alter the assigned phenotype of any of the subjects based on the established antimode of 0.95 (S/R-mephenytoin ratio). Two weeks after fluvoxamine was discontinued, both metabolic indices returned to their pre-study values. By contrast, fluvoxamine had no effect on either 0–8  h urinary metoprolol/α-hydroxymetoprolol ratio (95% confidence interval for difference between means: −0.38–0.46; P >0.05) or the 0–8  h urinary recovery of α-hydroxymetoprolol (95% confidence interval for difference between means: −0.61–0.70  mg; P >0.05). These results indicated fluvoxamine has a modest inhibitory effect on the activity of CYP2C19, but no effect on that of CYP2D6 in vivo .     

齐拉西酮联用氟伏沙明治疗难治性抑郁症的临床对照研究

目的：观察齐拉西酮联用氟伏沙明治疗难治性抑郁症的疗效。方法：将符合条件的60例难治性抑郁症患者随机分成两组,分别给与齐拉西酮联用氟伏沙明（联用组）和单用氟伏沙明（对照组）,进行12周的系统治疗,使用HAMD（汉密尔顿抑郁量表）和HAMA（汉密尔顿焦虑量表）评估其疗效;以TESS（副反应量表）和有关的实验室检查评定副反应。结果：治疗以后两组患者的HAMD评分均明显下降,联用组的治疗效果较好,两组之间差异存在显著性（P〈0.01）,并且联用组起效快;而两组HAMA量表的评分明显下降,联用组的治疗效果较好,两组之间差异存在显著性（P〈0.01）,联用组起效快,联用组的副反应发生率高于对照组,但差异无显著性;两组药物引起的副反应均为轻度或中度,表现有所不同,患者耐受性好。结论：齐拉西酮联用氟伏沙明治疗难治性抑郁症的疗效优于单独使用氟伏沙明组,且联用组起效较快,并且对于焦虑症状的改善好于对照组;两组副反应较轻,副反应的表现有所不同。联用这两种药物对于治疗难治性抑郁症具有良好的疗效,且安全性高。     

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。     

氟伏沙明联合阿立哌唑治疗儿童少年强迫障碍对照研究

目的：探讨氟伏沙明联合阿立哌唑治疗儿童少年强迫障碍的临床疗效和安全性。方法将80例儿童少年强迫障碍患者随机分为两组,每组40例,均口服氟伏沙明治疗,研究组在此基础上联合阿立哌唑治疗。观察8周。采用Yale-Brown强迫量表和副反应量表评定临床疗效和不良反应。结果治疗8周末,研究组显效率77．5％、总有效率92．5％,对照组分别为57．5％、87．5％,研究组显效率显著高于对照组（χ^2＝4．53,P＜0．05）。两组不良反应均轻微,治疗各时段副反应量表评分比较差异均无显著性（P＞0．05）。结论伏氟沙明联合阿立哌唑治疗儿童少年强迫障碍起效快,疗效显著,安全性高,优于单用伏氟沙明治疗。     

氟伏沙明联合氯米帕明治疗强迫症对照研究

目的探讨氟伏沙明联合氯米帕明治疗强迫症的临床疗效及安全性。方法将45例强迫症患者随机分为两组,研究组25例,口服氟伏沙明联合氯米帕明治疗;对照组20例,单用氯米帕明治疗。观察8w。于治疗前及治疗8w末采用Yale-Brown强迫量表,汉密顿焦虑量表、汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应。结果治疗8w末研究组显效率为80%,对照组为50%,研究组显效率显著高于对照组（χ^2=4.09,P〈0.05）。Yale-Brown强迫量表,汉密顿焦虑量表、汉密顿抑郁量表评分,治疗8w末两组均较治疗前有显著下降（P均〈0.01）,但研究组均较对照组下降显著（P均〈0.05）。研究组不良反应多在联用氯米帕明治疗的第1w出现,且程度及发生率显著低于对照组。结论氟伏沙明联合氯米帕明治疗强迫症疗效显著,且安全性高。     

氟伏沙明与氟汀治疗强迫症对照研究

目的探讨氟伏沙明与氟西汀治疗强迫症的临床疗效及安全性。方法将48例强迫症患者随机分为研究组25例,对照组23例,研究组口服氟伏沙明治疗,对照组口服氟西汀治疗,观察8w。于治疗前及治疗2w、4w、8w末采用Yale—Brown强迫量表、汉密顿抑郁量表、副反应量表评定临床疗效和不良反应。结果治疗8w末研究组有效率为84％,对照组为82．6％;Yale-Brown强迫量表、汉密顿抑郁量表评分,研究组治疗2w末起,对照组治疗4w末起较治疗前均有显著下降（P〈0．05或0．01）;研究组治疗2w末均较对照组下降显著（P〈0．05）,其它时点评分均无显著性差异（P〉O．05）;两组不良反应发生率较低,程度较轻微,经对症处置后可消失或缓解。结论氟伏沙明治疗强迫症疗效与氟西汀相当,安全性高,服药依从性好,但氟伏沙明治疗起效更快。     

Relationship between fluvoxamine and stress barometer for nocturnal enuresis

BACKGROUND: It has been reported recently that fluvoxamine (a selective serotonin reuptake inhibitor) is effective and safe for children with monosymptomatic nocturnal enuresis (MNE). However, the exact mechanism by which fluvoxamine is beneficial in the treatment of MNE remains unknown. One possibility is that it controls emotional stress. METHODS: We divided children with MNE into primary MNE (n = 40) and secondary MNE (n = 7). We measured urinary 17-hydroxycorticosteroids (17-OHCS) and 17-ketosteroid sulfates (17-KS-S) as a stress barometer in children with MNE to evaluate adaptation to emotional stress before and during fluvoxamine treatment. We initially administered fluvoxamine at a dose of 25 mg at bedtime. If patients remained incontinent after 3 weeks, we increased the dose to 50 mg. RESULTS: Fluvoxamine was effective in 26 of 28 children (93%) with primary MNE and an abnormality of the stress barometer and in six of six children (100%) with secondary MNE and an abnormality of the stress barometer. Fluvoxamine was effective in only six of 12 children (50%) with primary MNE and normality of the stress barometer and was not effective in one child with secondary MNE and normality of the stress barometer. CONCLUSIONS: The stress barometer is useful clinically for evaluating the therapeutic effect of fluvoxamine for children with MNE.     

Aggravation of food-related behavior in an adolescent with Prader-Willi syndrome treated with fluvoxamine and fluoxetine.

Prader-Willi Syndrome is a congenital multisystem disorder, characterized by a typical dysmorphism, mental retardation, hyperphagia due to insatiable appetite, and resultant morbid obesity. Psychiatric symptoms include obsessions and temper tantrums. METHOD: Pharmacotherapy is experimental with a few reports of successful fluoxetine treatment. RESULTS: We report an aggravation in the food-related symptoms and a consequent weight gain in an adolescent with Prader-Willi syndrome, who was treated with fluvoxamine and fluoxetine.     

Increased libido during fluvoxamine treatment

We treated an 80-year-old man with vascular dementia who developed increased libido induced by fluvoxamine. Sexual stimulation associated with fluvoxamine administration has been rarely reported and the present findings suggest that organic brain dysfunction could be a risk factor for the development of the condition.