Efficacy, tolerability and side-effect profile of fluvoxamine for major depression: meta-analysis

Abstract

Fluvoxamine, one of the oldest selective serotonin reuptaking inhibitors, is commonly prescribed to patients with major depression. Several studies have reviewed the efficacy and tolerability of fluvoxamine for the treatment of major depression. However, these reviews are outdated, have not been systematic and/or suffered from several methodological weaknesses. We conducted a systematic review to synthesize the best available evidence on the efficacy of fluvoxamine for adult patients suffering from major depression in comparison with other active antidepressive agents. Relevant randomized controlled trials were identified through a comprehensive search. The primary outcome was a relative risk of response, and the secondary outcome was a relative risk of remission. Tolerability and side-effect profile were also examined. Fifty-three trials were included. There were no large differences between fluvoxamine and any other antidepressants in terms of efficacy and tolerability. There is evidence of differing side effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclics. Clinicians should focus on practically or clinically relevant differences including those in side-effect profiles.

Serum proBDNF/BDNF and response to fluvoxamine in drug-naïve first-episode major depressive disorder patients

“…Fluvoxamine is an SSRI that is widely used for treatment of depression and other psychiatric disorders and has been suggested to have early effects when used as an antidepressant drug [4,5]. In addition, the results of a meta-analysis have shown that significant improvements in Hamilton Rating Scale for Depression (HAMD) scores achieved in the first few weeks were maintained after 6 weeks of treatment [6]. Results of a recent meta-analysis also suggest that treatment with fluvoxamine leads to symptomatic improvements in patients with MDD by the end of the first week of use [6].…”

Differences in clinical effect and tolerance between fluvoxamine and paroxetine: A switching study in patients with depression

“…However, no differences have been detected in the remission rates of different selective serotonin reuptake inhibitors (SSRIs) during treatments for depression. A remission rate of 30-40% is standard for SSRIs, and these rates were comparable with those of tricyclic antidepressants (TCAs) (Bondolfi et al, 2006;Omori et al, 2009;Warden et al, 2007). Therefore, in daily clinical settings, more often than not, initial administrations of an SSRI do not lead to remission and it becomes necessary to switch to another antidepressant.…”

“…Fluvoxamine (FLV) and paroxetine (PRX) are, like other SSRIs, widely used in the treatment of depression. Several articles have been published suggesting that there are differences in the side effects induced by these two drugs (Mackay et al, 1997;Omori et al, 2009;Raeder Silvestri et al, 2001), but the details are unknown. Furthermore, to the extent of our knowledge, there have been no previous reports on substitution between these two drugs to examine whether discontinuation of the initial drug could serve as a predictor for the discontinuation of the subsequent drug treatment.…”

Do Benzodiazepines Plus Fluvoxamine Cause a Rapid Increase in Serum Brain-derived Neurotrophic Factor or Clinical Improvement in Major Depressive Disorder Patients?

“…Fluvoxamine, an SSRI that is widely used for treating depression and other psychiatric disorders, has been suggested to have early effects when used as an antidepressant drug [4,5]. Additionally, the results of a meta-analysis have shown that significant improvements in Hamilton Rating Scale for Depression (HAMD) scores that were achieved in the first few weeks were maintained after 6 weeks of treatment [6]. Sleep disturbances and anxiety are common co-occurring disturbances in patients with MDD and deserve particular attention.…”