Fluvoxamine in obsessive-compulsive disorder

McDougle, C.J., Goodman, W.K., Leckman, J.F., Barr, L.C., Henin-ger, G.R., and Price, L.H. (1993). The efficacy of fluvoxamine in obsessive compulsive disorder effects of comorbid chronic tic disorder./ Clin Psychopharmacol 13 354—358. 

Greist JH, Jenike MA, Robinson DS, et al Efficacy of fluvoxamine in obsessive-compulsive disorder results of a multicentre, double-bhnd, placebo-controlled trial. European Journal of Clinical Research 7 195-204, 1995c Griffin WST, Stanley LC, Ling C, et al Brain interleukin 1 and S-100 immunoreactivity are elevated in Down syndrome and Alzheimer disease. Proc Natl Acad Sci U S A 86 7611-7615, 1989... 

McDougle CJ, Goodman WK, I eckman JF, et al The efficacy of fluvoxamine in obsessive compulsive disorder effects of comorbid chronic tic disorder. J Clin... 

Goodman WK, Price LH, Rasmussen SA, et al. Efficacy of fluvoxamine in obsessive-compulsive disorder. Arch Gen Psychiatry 1989 46 36-44. 

McDougle CJ, Goodman WK, Leckman JF, Lee NC, Heninger GR, Price LH (1994) Haloperi-dol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 51 302-308... 

Cottraux J, MoUard E, Bouvard M, et al A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol 5(l) 17-30, 1989... 

Jenike MA, Surman OS, Cassem NH, et al Monoamine oxidase inhibitors in obsessive-compulsive disorder. J Clin Psychiatry 144 131-132, 1983 Jenike MA, Baer L, Minichiello WE, et al Concomitant obsessive-compulsive disorder and schizotypal personality disorder. Am J Psychiatry 143 530-533, 1986 Jenike MA, Flyman S, Baer L, et al A controlled trial of fluvoxamine in OCD. Am J Psychiatry 147 1209-1215, 1990... 

McDougle CJ, Price LH, Goodman WK, et al A controlled trial of lithium augmentation in fluvoxamine-refractory obsessive-compulsive disorder lack of efficacy. J Clin Psychopharmacol 11 175-184, 1991... 

McDougle CJ, Fleischmann RL, Epperson CN, et al Risperidone addition in fluvoxamine-refractory obsessive-compulsive disorder three cases [see comments]. J Clin Psychiatry 56 526-528, 1995... 

Erzegovesi S, Guglielmo E, Siliprandi F, Bellodi L. Low-dose risperidone augmentation of fluvoxamine treatment in obsessive-compulsive disorder a double-blind, placebo-controlled study. Eur Neuropsychopharmacol 2005 15 69-74. 

Strauss, W. L., Layton, M. E., Hayes, C. E. and Dager, S. R. (1997) 19F MRS of acute and steady state brain fluvoxamine levels in obsessive compulsive disorder. American Journal of Psychiatry, 151, 516-522. 

Obsessive compulsive disorder in an 8-year-old can be treated using fluvoxamine (selective serotonin reuptake inhibitor, SSRI). It is usually administered initially os 25 mg daily, and increased if necessary in steps of 25 mg every 4-7 days to a maximum of 200 mg daily. If there is no improvement within 10 weeks, treatment should be reconsidered. A selective serotonin reuptake inhibitor should not be started until 2 weeks after stopping a monoamine oxidase inhibitor (MAOl), and conversely a MAOl should not be started until at least a week after an SSRI has been stopped. 

Citalopram, escitalopram, and paroxetine are not approved for use in pediatric patients. Fluoxetine is approved for use in pediatric patients with MDD and obsessive-compulsive disorder (OCD). Sertraline is not approved for use in pediatric patients except for patients with OCD. Fluvoxamine is not approved for use in pediatric patients except for patients with OCD. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

In the United States, fluvoxamine is only prescribed for the treatment of obsessive-compulsive disorder. It is not structurally related to the previously mentioned SSRIs, but it does have similar actions on serotonin reuptake systems. Fluvoxamine often comes in 50-mg tablets. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

The selective serotonin reuptake inhibitors (SSRls) have received increased attention in the treatment of anxiety disorders. With the recent Food and Drug Administration (FDA) approval of fluoxetine and fluvoxamine in the treatment of obsessive-compulsive disorder, it has been made clear that this... 

Goodman WK, Price LH, Delgado PL, et al Specificity of serotonin reuptake inhibitors in the treatment of obsessive compulsive disorder comparison of fluvoxamine and desipramine. Arch Gen Psychiatry 47 577-585, 1990b Goodman WK, Rasmussen SA, Foa EB, et al Obsessive compulsive disorder, in Clinical Evaluation of Psychotropic Drugs Principles and Guidance. Edited by Prien RF, Robinson DS. New York, Raven, 1994, pp 431-466 Goodnick P Effects of lithium on indices of 5HT and catecholamines in the clinical content a review. Lithium 1 65-73, 1990... 

Montgomery SA, Mancaux A Fluvoxamine in the treatment of obsessive compulsive disorder. Int Chn Psychopharmacol 7 (suppl l) 5-9, 1992... 

Zimelidine was the first serotonin reuptake inhibitor available for clinical use, but in 1982 was withdrawn worldwide because of its toxicity ( 110). Despite this initial setback, five members of this class have been marketed in the United States and various countries around the world citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). All except fluvoxamine have marketed indications in the United States for the treatment of major depression. Fluvoxamine is marketed in the United States for the treatment of obsessive-compulsive disorder rather than major depression, although it is marketed in a number of other countries for major depression. 

Goodman WK, et al. Fluvoxamine in the treatment of obsessive-compulsive disorder and related conditions. J Clin Psychiatry 1997 58[Suppl 5] 32-49. 

Fluoxetine Highly selective blockade of serotonin transporter (SERT) little effect on norepinephrine transporter (NET) Acute increase of serotonergic synaptic activity slower changes in several signaling pathways and neurotrophic activity Major depression, anxiety disorders panic disorder obsessive-compulsive disorder post-traumatic stress disorder perimenopausal vasomotor symptoms eating disorder (bulimia) Half-lives from 15-75 h oral activity Toxicity Well tolerated but cause sexual dysfunction Interactions Some CYP inhibition (fluoxetine 2D6, 3A4 fluvoxamine 1A2 paroxetine 2D6)... 

Mundo et al. (1993) gave a general description of their experience with patients who developed mania while taking clomipramine, fluoxetine, or fluvoxamine in their obsessive-compulsive disorder (OCD) clinic. According to the authors, when these patients were treated with pro-serotonergic antiobsessional drugs, they experienced reduced impulse control, dysphoria, and increased aggressiveness and reckless acts, symptoms similar to those found in mania. ... 

In 23 patients with obsessive-compulsive disorder who had not responded to a 6-month course of fluvoxamine (300 mg/day), olanzapine (5 mg/day) was added in an open comparison (28). There was a significant reduction in the mean score on the Yale-Brown Obsessive-Compulsive Scale concomitant schizotypal personality disorder was the only factor significantly associated with a response. The most common adverse effects were mild to moderate weight gain and sedation. 

In a two-phase placebo-controlled study with an initial sample of 45 patients, 39 of whom completed the study, the addition of low doses of risperidone (0.5 mg/day) appeared to improve symptoms in patients with obsessive-compulsive disorder taking fluvoxamine monotherapy (51). The main adverse events included transient sedation and mildly increased appetite. 

Although several antidepressants are EDA-approved for use in children, only one, fluoxetine, is currently approved for childhood depression. Imipramine is approved for the treatment of enuresis, clomipramine for obsessive-compulsive disorder in children 12 years and older, and fluvoxamine along with fluoxetine is approved for obsessive-compulsive disorder in children. The treatment of depression in children remains challenging, as depression can be difficult to diagnose and treat once identified. The studies involving imipramine, sertraline, and fluoxetine found that the dose range and titration as well as adverse effects were similar to those in adults. " ... 

Mundo E, Bianchi L, Bellodi L. Efficacy of fluvoxamine, paroxetine, and citalopram in the treatment of obsessive-compulsive disorder. J Qin Psychopharmacol 1997 17 267-271. 

Selective serotonin reuptake inhibitors (SSRIs) A relatively new group of medicines that have been used successfully to treat emotional and behavioral problems such as depression, panic disorder, obsessive-compulsive disorder ((XID), bulimia, and posttraumatic stress disorder in adults. These medications are now being used to treat the same types of behavior in children. Some examples of SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Paxil (paroxetine). 

An important area of research using in vivo F MRS has been the study of the pharmacokinetics of fluvoxamine and fluoxetine, drugs used to treat obsessive-compulsive disorder and depression, respectively. Several groups have shown that it is possible to detect these compounds noninvasively in the brain. Brain fluvoxamine levels were shown to reach a steady state 30 days after consistent daily dosing, substantially more rapidly than reported for fluoxetine, which was shown to plateau after 6-8... 

---