Fluoxetine vs. placebo for the treatment of recurrent vasovagal syncope with anxiety sensitivity

Flevari, Panayota; Leftheriotis, Dionyssios; Repasos, Evangelos; Katsaras, Dimitrios; Κατσιμάρδος, Ανδρέας; Lekakis, John

doi:10.1093/europace/euw153

Cited by 19 publications

(15 citation statements)

References 18 publications

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“…Individuals with high levels of anxiety sensitivity have a tendency toward showing exaggerated and prolonged reactions to anxiety‐provoking stimuli. A recent study examined whether fluoxetine, a serotonin‐reuptake inhibitor (SSRI) and effective therapy for anxiety and panic disorders, was able to prevent VVS in patients with elevated anxiety sensitivity (60/106 patients assessed) . The study found that patients receiving fluoxetine reported a significant decrease in the incidence of syncope and presyncope during follow‐up compared to patients receiving placebo (P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…A recent study examined whether fluoxetine, a serotonin-reuptake inhibitor (SSRI) and effective therapy for anxiety and panic disorders, was able to prevent VVS in patients with elevated anxiety sensitivity (60/106 patients assessed). 21 The study found that patients receiving fluoxetine reported a significant decrease in the incidence of syncope and presyncope during follow-up compared to patients receiving placebo (P < 0.05). SSRIs have also been suggested in the treatment of VVS due to the effect of serotonin on the modulation of heart rate and blood pressure, although results from previous studies have been mixed.…”

Section: Vvs and Psychological Distressmentioning

confidence: 91%

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Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals

Sheldon

Ritchie

et al. 2018

Pacing Clinical Electrophis

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Background Vasovagal syncope (VVS) patients have a reduced health‐related quality of life (HRQoL). There are limited data comparing HRQoL and psychological profile in VVS patients and healthy individuals. We tested the hypothesis that VVS patients have greater impairment in both HRQoL and psychological profile compared to healthy nonfainting individuals, and that both outcome measures are negatively correlated for VVS patients. Methods The RAND 36‐Item Health Survey (RAND36), global health visual analogue scale (VAS), Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, and Positive and Negative Affect Schedule – Expanded Form were completed by healthy individuals and at baseline by VVS patients enrolled in the Second Prevention of Syncope Trial, a randomized, placebo‐controlled trial of fludrocortisone for VVS. Results Data were available on 76 VVS patients (34 ± 14 years; 68% F) and 85 healthy participants (35 ± 11 years; 80% F). Compared to healthy participants, VVS patients reported poorer HRQoL on all scales of the RAND36 and the VAS. VVS patients had significantly greater anxiety, depression, and anxiety sensitivity (each P < 0.001). VVS patients had more negative affect (P < 0.001) and less positive affect (P = 0.003) compared to healthy participants. Anxiety, depression, and anxiety sensitivity were negatively correlated with HRQoL for VVS patients, but not for healthy participants. Conclusion In this first direct comparison, VVS patients have a significantly reduced HRQoL and more anxiety and depression compared to healthy nonfainting individuals. For VVS patients, there is a relationship between psychological distress and HRQoL, suggesting a potential benefit from more comprehensive assessment and treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Vvs and Psychological Distressmentioning

confidence: 91%

Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals

Sheldon

Ritchie

et al. 2018

Pacing Clinical Electrophis

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“…Also, SSRIs had a positive effect on the refractory recurrent syncope episodes [12,45]. A recent study demonstrated that fluoxetine could be considered as the first-line treatment in VVS patients with recurrent syncope episodes and psychogenic disorders [46]. Similarly, Kadri et al observed a significant improvement with citalopram treatment in syncope patients when the primary endpoint was considered as a well-being score (WS) [47].…”

Section: -Tse Was Correlated Significantly and Positively Withmentioning

confidence: 99%

The Relationship Between Clinical Characteristics and Psychological Status and Quality of Life in Patients with Vasovagal Syncope

Atıcı

Asoğlu

Demirkıran

et al. 2020

North Clin Istanbul

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Cite this article as: Atici A, Asoglu R, Demirkiran A, Serbest NG, Emektas B, Sarikaya R, et al. The relationship between clinical characteristics and psychological status and quality of life in patients with vasovagal syncope. North Clin Istanb 2020;7(3):237-245.S yncope is characterized by sudden and short-term loss of postural tone and consciousness [1]. Approximately 30% of the population has a syncope episode during their lifetime [2], and the most common cause is vasovagal syncope (VVS) [3]. VVS episode is usually self-limiting, but it may affect patients' quality of life and leads to disability due to falls [4][5][6]. Although the patho-physiological mechanisms underlying VVS are not fully understood, it may be explained by the lack of adaptive mechanisms that the regulation of the systemic blood pressure and the blood supply to the brain [7]. Tilt table test is generally used for the diagnosis of VVS [8].Stimulation of the limbic system, which is one of the main adaptive mechanisms, maybe causing VVS in case ABSTRACT OBJECTIVE: Syncope is characterized by sudden and short-term loss of postural tone and consciousness. Vasovagal syncope (VVS) episode is usually self-limiting, and it may affect patients' quality of life. In this study, we aimed to investigate the relationship between quality of life, Beck-depression and Beck-anxiety scales and clinical characteristics of the VVS patients. METHODS:The present study included 88 patients with VVS. Tilt table test was performed to all the patients. Patients filled out the Quality of life, Beck-depression, and Beck-anxiety scale forms. Demographics, medical history, echocardiography, blood pressures, electrocardiography and physical examination findings were recorded. RESULTS:There was a significant and negative correlation between the total syncope episodes (TSE) and EQ-5D index and EQ-5D-VAS index, respectively (p<0.001, r: -0.649; p<0.001, r: -0.587). TSE was significantly and positively correlated with the Beck-anxiety scale and Beck-depression scale. EQ-5D index, EQ-5D-VAS index, Beck-depression scale, and Beck-anxiety scales were defined as an independent predictor of TSE in VVS patients. CONCLUSION:Psychological factors play an essential role in VVS patients. EQ-5D index, EQ-5D-VAS index, Beck-depression, and Beck-anxiety scales were an independent predictor of the TSE in patients with VVS.

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“…The study by Flint et al found a correlation between psychosocial impairment and response to treatment [14], which supports the recommendation that patients with VVS, who presents with psychosocial impairment should undergo a psychiatric evaluation by a therapist, especially in the light of other evidence that indicated the usefulness of psychotherapy and antidepressants in the treatment of refractory VVS [15][16][17][18][19]. This study was limited by the use of self-report measures for the psychosocial evaluation, and it didn't control for other co-morbidities that can affect the psychiatric condition of the patients.…”

Section: The Relationship Between Vvs and Psychological Distressmentioning

confidence: 77%

Anxiety and Depression as Risk Factors for Vasovagal Syncope and Potential Treatment Targets: A Systematic Review

Abuzainah¹,

Gutlapalli²,

Chaudhuri³

et al. 2022

Cureus

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Vasovagal syncope (VVS) is a transient, sudden loss of consciousness followed by complete resolution, usually due to a paradoxical autonomic reaction that results in hypotension and/or bradycardia. In this study, we assessed the correlation between VVS and a patient's psychiatric status, as well as if this association could be a target in the treatment of those patients. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the available literature using the following databases: PubMed, Google Scholar, and ScienceDirect, with last access on July 21, 2022. The search resulted in 1691 articles, and inclusion and exclusion criteria were applied to nine remaining articles, all of which were accepted after using the quality assessment tools, four observational and four randomized controlled trials (RCTs). Four of the included studies assessed the correlation among vasovagal syncope, psychosocial impairment, and quality of life. We found a consistent correlation among VVS, psychosocial impairment, and quality of life (QoL), meaning that VVS patients usually have some degree of psychosocial impairment, especially in the form of anxiety and depression, and a poorer QoL in comparison to their healthy counterparts. The use of psychotherapy and antidepressants was proven to be effective in VVS in RCTs, but further evidence is needed.

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Fluoxetine vs. placebo for the treatment of recurrent vasovagal syncope with anxiety sensitivity

Abstract: Sensitivity to anxiety is a common personality trait in recurrent VVS. Fluoxetine is superior to placebo against syncope in these patients. This drug may be a first-line pharmacological treatment for this difficult-to-treat group.

Cited by 19 publications

References 18 publications

Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals

Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals

The Relationship Between Clinical Characteristics and Psychological Status and Quality of Life in Patients with Vasovagal Syncope

Anxiety and Depression as Risk Factors for Vasovagal Syncope and Potential Treatment Targets: A Systematic Review

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