Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder

Xue, Lixin; Li, Xinyuan; Zhang, Congxiao; Sun, Mingze; Sun, Ziqian; Xu, Yanan; Tian, Xiujuan

doi:10.1097/md.0000000000011547

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…Nevertheless, this review included rankings of medications which are missing in previous published NMAs and includes the gradings of RCTs by medication class which is a novel method of interest by the GRADE Working Group. The data included in this review are also consistent with findings from other systematic reviews and meta-analyses in identifying that SSRIs like paroxetine are first-line agents for the treatment of SAD (Ballenger et al, 1998;Bandelow et al, 2002;Bandelow et al, 2012;Bandelow & Michaelis, 2015;Blanco et al, 2003;Van der Linden et al, 2000), aside from documented differences in the incidence of specific adverse events, existing evidence for a NMA does not suggest differences in the effectiveness of this drug(s) (Blanco et al, 2003;Hansen et al, 2008;Liu et al, 2018;Mayo-Wilson et al, 2014). The outcomes of this review are also generalisable to a diverse range of settings, and the interventions targeted both men and women across a wide age range.…”

Section: Discussionsupporting

confidence: 78%

Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Williams

McCaul

Schwarzer

et al. 2020

Acta Neuropsychiatr.

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AbstractObjective:The aim of this paper was to provide a systematic review and update on the pharmacotherapy of social anxiety disorder (SAD), including the efficacy and tolerability of these agents, the ranking of interventions, and the grading of results by quality of evidence.Methods:The Common Mental Disorder Controlled Trial Register and two trial registries were searched for randomised controlled trials (RCTs) comparing any pharmacological intervention or placebo in the treatment of SAD. We performed a standard pairwise meta-analysis using a random effects model and carried out a network meta-analysis (NMA) using the statistical package, R. Quality of evidence was also assessed.Results:We included 67 RCTs in the review and 21 to 45 interventions in the NMA. Paroxetine was most effective in the reduction of symptom severity as compared to placebo. Superior response to treatment was also observed for paroxetine, brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline. Higher dropout rates were found for fluvoxamine. Brofaromine, escitalopram, fluvoxamine, paroxetine, pregabalin, sertraline, and venlafaxine performed worse in comparison to placebo for the outcome of dropouts due to adverse events. Olanzapine yielded a relatively high rank for treatment efficacy and buspirone the worse rank for dropouts due to any cause.Conclusion:The differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine. We suggest paroxetine as a first-line treatment of SAD, with the consideration of future research on the drug olanzapine as well as brofaromine, bromazepam, clonazepam, escitalopram, fluvoxamine, phenelzine, and sertraline because we observed a response to treatment.

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Section: Discussionsupporting

confidence: 78%

Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Williams

McCaul

Schwarzer

et al. 2020

Acta Neuropsychiatr.

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“…One hundred and two meta‐analyses fulfilled the inclusion criteria (see Figure 1 and supplementary information). These encompassed 69 meta‐analytic comparisons of pharmacotherapies with placebo or TAU, 26 comparisons of psychotherapies with placebo or TAU, 11 comparisons of psychotherapies vs. pharmacotherapies head‐to‐head, and 13 comparisons of combined psychotherapy and pharmacotherapy to either monotherapy 6,12,13,34‐134 . The 102 meta‐analyses encompassed 3,782 RCTs (range: 2 to 522) and 650,514 patients (range: 65 to 116,477) (see supplementary information).…”

Section: Resultsmentioning

confidence: 99%

“…In the largest meta-analyses for anxiety disorders, pharmacotherapies achieved SMDs in comparison to placebo between 0.33 and 0.45 53,56,64 (see Figure 2). Overall, effect sizes for pharmacotherapy were between 0.01 and 0.56, with the majority of effect sizes being small 53,[55][56][57][58][59][60][61][62][63][64]66,67,69,70 (see supplementary information). RR ranged between 1.20 and 4.03, with most values being small, one medium (monoamine oxidase inhibitors), and one large (benzodiazepines, RR=4.03) 69 .…”

Section: Anxiety Disordersmentioning

confidence: 99%

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

et al. 2022

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Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta‐analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta‐analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta‐analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment‐as‐usual (TAU), or psychotherapies vs. pharmacotherapies head‐to‐head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta‐analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post‐traumatic stress disorder, obsessive‐compulsive disorder, somatoform disorders, eating disorders, attention‐deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta‐analytic evaluation of the effect sizes reported by the largest meta‐analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26‐0.42) for psychotherapies and 0.36 (95% CI: 0.32‐0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head‐to‐head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: –0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19‐0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.

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“…Paroxetine is a drug indicated for the treatment of variety of anxiety disorders, including generalized anxiety disorder (GAD, ICD-10-CM code: F41.1 [ 17 ]), obsessive–compulsive disorder (OCD, ICD-10-CM code: F42.3, F42.2, F42.9, F42.8 [ 18 ]), major depressive disorder (MDD, ICD-10-CM code: F32, F33 [ 19 ]), premenstrual dysphoric disorder (PDD, ICD-10-CM code: F32.81 [ 20 ]), post-traumatic stress disorder (PTSD, ICD-10-CM code:F43.1 [ 21 ]), panic disorder (PD, ICD-10-CM code: F41.0 [ 22 ]), social anxiety disorder (SAD, ICD-10-CM code: F40.1, F40.10, F40.11 [ 5 ]) and vasomotor symptoms [ 23 , 24 , 25 , 26 ]. It is worth emphasizing that in the treatment of PTSD there are only two approved pharmacotherapies based on SSRIs, including Paxil (paroxetine hydrochloride).…”

Section: Paroxetine—general Information and Historymentioning

confidence: 99%

“…[ 47 ]. In addition to hydrochloride, paroxetine mesylate is also available [ 23 ]. It can be concluded that nowadays, the structure of paroxetine is well-researched and understood ( Figure 1 ).…”

Section: Paroxetine—chemistrymentioning

confidence: 99%

Paroxetine—Overview of the Molecular Mechanisms of Action

Kowalska

Nowaczyk

Fijałkowski

et al. 2021

IJMS

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In the 21st century and especially during a pandemic, the diagnosis and treatment of depression is an essential part of the daily practice of many family doctors. It mainly affects patients in the age category 15–44 years, regardless of gender. Anxiety disorders are often diagnosed in children and adolescents. Social phobias can account for up to 13% of these diagnoses. Social anxiety manifests itself in fear of negative social assessment and humiliation, which disrupts the quality of social functioning. Treatment of the above-mentioned disorders is based on psychotherapy and pharmacotherapy. Serious side effects or mortality from antidepressant drug overdose are currently rare. Recent studies indicate that paroxetine (ATC code: N06AB), belonging to the selective serotonin reuptake inhibitors, has promising therapeutic effects and is used off-label in children and adolescents. The purpose of this review is to describe the interaction of paroxetine with several molecular targets in various points of view including the basic chemical and pharmaceutical properties. The central point of the review is focused on the pharmacodynamic analysis based on the molecular mechanism of binding paroxetine to various therapeutic targets.

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Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 26 publications

Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

Paroxetine—Overview of the Molecular Mechanisms of Action

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