Fluvoxamine

Fluvoxamine is an antidepressant that belongs to the group of selective serotonin reuptake inhibitors. In Germany, the active ingredient was approved for the treatment of depression and obsessive-compulsive disorder, but is also often used to treat anxiety and panic disorders as well as post-traumatic stress disorders. When using the drug, interactions with other drugs such as monoamine oxidase inhibitors (MAOIs) must be considered, and significant side effects can occur.

What is fluvoxamine?

Fluvoxamine is a drug with the chemical molecular formula C15H21F3N2O2. It contains a monocyclic aromatic ring and has been approved as an antidepressant in Germany since the mid-1980s. The medicine belongs to a group of selective serotonin reuptake inhibitors (SSRIs). The abbreviation SSRI is derived from the English term "selective serotonin reuptake inhibitor".

The monocyclic structure and its special binding ability and affinity to the σ-receptors (sigma receptors) distinguish fluvoxamine from most other antidepressants, which have a special binding affinity to opioid receptors.

The active ingredient shows, among other things, a strong interaction with reversible and irreversible MAO inhibitors (monoamine oxidase inhibitors), which non-selectively inhibit the breakdown of neurotransmitters such as serotonin, noradrenaline and dopamine and are also used as antidepressants. Fluvoxamine must therefore not be taken together with MAO inhibitors. Before switching from MAO inhibitors to fluvoxamine or vice versa, specified waiting times must be observed.

Pharmacological effect

As a selective serotonin reuptake inhibitor, fluvoxamine only influences the reuptake or the return transport of serotonin into the vesicles of certain cells or the breakdown of this neurotransmitter, so that its concentration in the synaptic gap increases.

Due to the selective mode of action of the drug, the breakdown or return transport of the other neurotransmitters from the group of monoamines such as adrenaline, dopamine, melatonin and others are not impaired. Fluvoxamine therefore leads to a one-sided increase in the concentration of serotonin in the synaptic gap due to its longer residence time there.

As a neurotransmitter in the central nervous system (CNS), psychological effects are ascribed to the monoamine serotonin. Serotonin is considered to be mood-enhancing, motivating and anxiety-relieving. Serotonin deficiency can often be demonstrated in depressed moods and depression. Assuming that eliminating the reduced serotonin concentration also resolves the depressive mood, attempts are made to eliminate the relative deficiency by supplying additional serotonin or by preventing rapid inactivation of the messenger substance.

The intake of fluvoxamine leads to an increased serotonin concentration by inhibiting the rapid inactivation of serotonin. If the serotonin concentration exceeds a certain level, the effect of the messenger substance can be almost reversed. Serotonin syndrome sets in, which is typically characterized by symptoms such as anxiety, anxiety, muscle tension, tremors and muscle twitching.

A serotonin syndrome can develop, for example, if the interaction of fluvoxamine with MAO inhibitors is not taken into account and an uncontrollably high serotonin level develops.

Medical application & use

In its capacity as a selective serotonin reuptake inhibitor, the intake of fluvoxamine leads to an increase in the serotonin level in the blood and can therefore be considered for the treatment of all mental illnesses that are associated with a lowered serotonin level. This applies primarily to pathological depression.

It is not yet sufficiently known whether manifest depression is the cause or consequence of the serotonin deficiency.Fluvoxamine is therefore primarily prescribed to treat depression.

According to its original approval in the mid-1980s, the drug is also expressly intended to improve OCD. In the course of further applications that go well beyond the originally researched spectrum of diseases, the drug is also often used for the therapy of anxiety disorders, panic attacks, post-traumatic stress disorders and social phobia as well as irritable bowel syndrome. Even with diagnosed borderline syndrome, which can be classified in the border region between neurosis and manifest psychosis, treatment with the SSRI fluvoxamine is quite common.

The empirical knowledge has prevailed that anxiety disorders, which can develop into a social phobia, for example, are also accompanied by a lowered serotonin level. In order to treat the social phobia yourself and thus prevent the development of a number of negative side effects, the use of fluvoxamine is considered by many doctors and sometimes preferred.

In addition to its effectiveness, the drug is often valued for its relatively short physiological half-life of around 15 hours. The short half-life allows a rapid switch to an alternative psychotropic drug within a few days if an intolerance to the agent is determined.

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Risks & side effects

Like other inhibitors of selective serotonin inhibitors, fluvoxamine intervenes in the metabolism of monoamines in a relatively insensitive, one-sided and systemic manner. There is a one-sided increase in the serotonin concentration in the nervous system, without the related systemic effects on many relevant metabolic processes being fully understood.

Despite the undoubted successes of treatment to improve a number of psychopathological diseases, the use of fluvoxamine is often accompanied by undesirable side effects. After taking fluvoxamine, anxiety, drowsiness, tremors and difficulty sleeping can occur. Likewise, there is often an increase in heart rate as well as sweating and hypersensitivity reactions of the skin.

Serotonin syndrome, a toxic oversupply of serotonin, can develop, especially in combination with drugs that otherwise increase the serotonin level. Serotonin syndrome is typically accompanied by decreased consciousness, frozen muscles, tremors and fever and requires immediate medical attention.