Obsessive-compulsive disorder fluvoxamine

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

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. 

Obsessive-compulsive disorder (OCD) Fluoxetine fluvoxamine paroxetine (immediate-release), sertraline. 

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... 

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. 

Riddle, M.A., Reeve, E.A., Yaryura-Tobias, J.A., Yang, H.M., Clagh-orn, J.L., Gaffney, G., Greist, J.H., Holland, D., McConville, B.J., Pigott, T., and Walkup, J.T. (2001) Fluvoxamine for children and adolescents with obsessive-compulsive disorder a randomized, controlled, multicenter trial. / Am Acad Child Adolesc Psychiatry 40 222-229. 

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). 

Apter, A., Ratzoni, G., King, R., Weizman, A., lancu, I., Binder, M., and Riddle, M. (1994) Fluvoxamine open-label treatment of adolescent inpatients with obsessive-compulsive disorder or depression. J Am Acad Child Adolesc Psychiatry 33 342-348. 

Fennig, S., Fennig, S., Pato, M., and Weitzman, A. (1994) Emergence of symptoms of Tourette s syndrome during fluvoxamine treatment of obsessive-compulsive disorder. Br J Psychiatry 164 839-841. 

Bogetto, F, Bellino, S., Vaschetto, P., and Ziero, S. (2000) Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD) a 12-week open trial. Psychiatry Res 96 91-98. 

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... 

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... 

Delgado PL, Goodman WK, Price LH, et al Fluvoxamine/pimozide treatment of concurrent Tourette s and obsessive compulsive disorder. Br J Psychiatry 157 762-765, 1990a... 

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... 

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... 

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 Fluvoxamine treatment of coincident autistic disorder and obsessive compulsive disorder a case report. J Autism Dev Disord 20 537-543, 1990a... 

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

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... 

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. 

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

Perse TL, Greist JH, Jefferson JW, et al. Fluvoxamine treatment of obsessive-compulsive disorder. Am J Psychiatry 1987 144 1543-1548. 

Koran LM, McElroy SL, Davidson JRT, et al. Fluvoxamine versus clomipramine for obsessive-compulsive disorder a double-blind comparison. J Clin Psychopharmacol 1996 16 121-129. 

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