Rabbit Syndrome is an uncommon side effect of antipsychotic treatment. Although it is usually associated with typical antipsychotics, it can also be related to atypical antipsychotics. Anticholinergics are the most accepted treatment approach in treating Rabbit Syndrome. Fluvoxamine is a member of selective serotonin reuptake inhibitors and it is a potent agonist of sigma 1 receptors. In this article, we report a Rabbit Syndrome case who has benefited from fluvoxamine, in terms of both depressive disorder and Rabbit Syndrome; and present the data on the effects of sigma 1 agonist fluvoxamine on numerous movement disorders.
Antipsychotic Agents ; Cholinergic Antagonists ; Depressive Disorder ; Fluvoxamine ; Movement Disorders ; Receptors, sigma ; Serotonin Uptake Inhibitors

To observe the clinical efficacy of dopamine modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) augmentation of ongoing fluvoxamine treatment in refractory obsessive-compulsive disorder (OCD) and its effects on patient's anxiety and sleep quality.
 Methods: A pilot randomized, placebo-controlled, and double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor treatment-refractory OCD and they received a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. The 44 patients were randomly assigned into a study group and a control group, with 22 patiencs in each group. Fluvoxamine and MPH-ER were given to the study group, while fluvoxamine and placebo were given to the control group, with 8 weeks of the treatment course. Y-BOCS, Hamilton Anxiety Scale (HAMA) were used to assess the efficacy, Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality, and Treatment Emergent Symptom Scale (TESS) was used to evaluate the side effects. Data were analyzed in the intention-to-treat sample.
 Results: The improvement in the Y-BOCS total score, Y-BOCS obsession subscale score and HAMA score were more prominent in the study group than those in the control group (P<0.001). There was no significant difference in PSQI score and TESS score between the two groups. MPH-ER was well tolerated.
 Conclusion: Fluvoxamine combined with MPH-ER is effective in the treatment of refractory obsessive-compulsive disorder. It can improve anxiety and has no adverse effect on sleep quality.
Adult ; Double-Blind Method ; Drug Therapy, Combination ; Fluvoxamine ; therapeutic use ; Humans ; Methylphenidate ; therapeutic use ; Obsessive-Compulsive Disorder ; drug therapy ; Psychiatric Status Rating Scales ; Treatment Outcome

Nowadays newer antidepressants are commonly used in clinical practice, since they are as effective as tricyclic antidepressant, but show less adverse effects. However there are many unexpected adverse effects of these drugs. It is one of the most common causes of treatment failure. I reviewed these adverse effects and pharmacological management focusing on common but under-recognized adverse effects of newer antidepressant. I reviewed newer antidepressant-induced sleep related movement disorder, sweating, tremor, abnormal bleeding. In this paper, newer antidepressants include selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine), serotonin norepinephrine reuptake inhibitor (venlafaxine, duloxetine), norepinephrine and dopamine reuptake inhibitor (bupropion), noradrenergic and specific serotonergic antidepressant (mirtazapine), and reversible inhibitor of monoamine oxidase A (moclobemide). I suggest that psychiatrists should know not only well-recognized but also under-recognized common adverse effects and their pharmacological management of newer antidepressants, so that it will be helpful to treat patients with psychiatric illness using newer antidepressants and to make better outcome.
Antidepressive Agents* ; Citalopram ; Dopamine ; Fluvoxamine ; Hemorrhage ; Humans ; Monoamine Oxidase Inhibitors ; Movement Disorders ; Norepinephrine ; Psychiatry ; Serotonin ; Sertraline ; Sweat ; Sweating ; Treatment Failure ; Tremor

Fluvoxamine is a selective serotonin reuptake inhibitor that is approved for psychiatric disorders such as major depressive episodes and obsessive-compulsive disorder. Beside inhibition of serotonin reuptake, fluvoxamine is also a potent agonist of endoplasmic reticulum (ER) protein sigma-1 receptors, which play a role in the pathophysiology of a number of psychiatric and neurodegenerative disorders. This report presents beneficial effects of sigma-1 agonist fluvoxamine on hyperkinetic movement disorders such as tardive dyskinesia and tardive akathisia. Fluvoxamine might be a novel treatmet approach in the treatment of hyperkinetic movement disorders.
Akathisia, Drug-Induced* ; Dyskinesias ; Endoplasmic Reticulum ; Fluvoxamine* ; Humans ; Hyperkinesis ; Movement Disorders* ; Neurodegenerative Diseases ; Obsessive-Compulsive Disorder ; Psychomotor Agitation ; Receptors, sigma ; Schizophrenia* ; Serotonin

Newer antidepressants are commonly used in clinical practice to treat psychiatric disorder and psychosomatic disorder including chronic pain syndrome, fibromyalgia, headache. However there are many unexpected adverse effects of these drugs such as nausea and vomiting, weight gain, sexual dysfunction. These are 3 most well-recognized common adverse effects of newer antidepressant and are most common causes of treatment failure. I reviewed mechanisms, epidemiology, and pharmacological management of these adverse effects of newer antidepressants. In this paper, newer antidepressants include selective serotonin reuptake inhibitor(fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine), serotonin norepinephrine reuptake inhibitor(venlafaxine, duloxetine), norepinephrine and dopamine reuptake inhibitor(bupropion), noradrenergic and specific serotonergic antidepressant(mirtazapine), and reversible inhibitor of MAO-A(moclobemide). I suggest that psychiatrists and clinicians in the psychosomatic field should know mechanisms, epidemiology, and management of these common and well-recognized adverse effects of newer antidepressants. Therefore it will be helpful to recognize easily and treat well for patients with psychiatric disorder and psychosomatic disorder using newer antidepressants.
Antidepressive Agents ; Chronic Pain ; Citalopram ; Dopamine ; Epidemiology* ; Fibromyalgia ; Fluvoxamine ; Headache ; Humans ; Nausea* ; Norepinephrine ; Psychiatry ; Psychophysiologic Disorders ; Serotonin ; Sertraline ; Treatment Failure ; Vomiting* ; Weight Gain*

There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.
Amiodarone ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Arrhythmia Agents ; Bupropion ; Calcium Channel Blockers ; Cardiovascular Agents ; Chlorpromazine ; Cholesterol ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes ; Digoxin ; Diltiazem ; Diuretics ; Drug Interactions ; Drug Toxicity ; Fluvoxamine ; Haloperidol ; Lithium ; Psychotropic Drugs ; Quinidine ; Serotonin Uptake Inhibitors ; Triazoles ; Verapamil ; Warfarin

Legalized gambling is a growing industry, and is probably a factor in the presently increasing prevalence of pathological gambling. We present a case of a 36-year-old pathological gambler who was treated with fluvoxamine, a selective serotonin reuptake inhibitor, and who was assessed by functional MRI before and after drug administration. During activation periods, the pathological gambler was shown cards as stimuli, and fMRI results in several brain regions showed differential effects before and after medication and a maintenance period. This case demonstrates that the treatment response to fluvoxamine in a pathological gambler was observed not only by subjective self-report, but also by objective fMRI results. Therefore, fMRI may be a useful tool in the diagnosis and prediction of treatment response in patients afflicted with pathological gambling.
Adult ; Behavior, Addictive/*drug therapy ; Fluvoxamine/*therapeutic use ; *Gambling ; Humans ; Magnetic Resonance Imaging ; Male ; Serotonin Uptake Inhibitors/*therapeutic use ; Treatment Outcome

Polypharmacy has recently become usual practice in the treatment of patients with mood disorders. In this article, we review the results of recent studies on metabolic drug interactions between anticonvulsants, atypical antipsychotics, and antidepressants. Important drug interactions in clinical practice may be summarized as follows. First, valproate may increase the serum level of carbamazepine and its active metabolite carbamazepine-epoxide, quetiapine, and lamotrigine. In particular, in combined regimens of lamotrigine and valproate, the dose of lamotrigine needs to be downwardly titrated, due to the potential risk of skin lesions. Second, there are numerous carbamazepine-associated interactions that need careful monitoring, because carbamazepine is a well-known inducer of CYP1A2, CYP2C9, and CYP2C19. Thus, in patients receiving carbamazepine, clinically significant decreases in serum levels may be found for drugs metabolized by these enzymes. Third, atypical antipsychotics are primarily metabolized by CYP2D6 and CYP3A4, thereby compromising the use of inhibitors of these enzymes. Fourth, most selective serotonin-reuptake inhibitors (SSRIs) are actually inhibitors of diverse enzyme systems, indicating at least potential problems with increased serum levels. While paroxetine, fluoxetine, and fluvoxamine strongly inhibit CYP enzymes, citalopram, venlafaxine, mirtazapine, and bupropion do so weakly. In conclusion, understanding drug-drug interactions is essential in planning individualized pharmacotherapy with diverse therapeutics. In treating patients with mood disorders, special concern should be paid to combination therapy using valproate, carbamazepine, and some SSRIs.
Anticonvulsants ; Antidepressive Agents ; Antipsychotic Agents ; Bupropion ; Carbamazepine ; Citalopram ; Cyclohexanols ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP2D6 ; Dibenzothiazepines ; Drug Interactions ; Fluoxetine ; Fluvoxamine ; Humans ; Mianserin ; Mood Disorders ; Paroxetine ; Polypharmacy ; Skin ; Triazines ; Valproic Acid ; Quetiapine Fumarate ; Venlafaxine Hydrochloride

OBJECTIVE: Obsessive-compulsive disorder (OCD) is one of the more common serious mental illnesses. Effective psychological and drug treatments are available for the distressing, time-consuming, repetitive thoughts and rituals and the associated functional impairment. The decision of a treatment, however, is not easy because of the various clinical features and many treatment options. Therefore, practice guidelines and algorithms have been developed in some countries to provide the proper information to clinicians. We sought to develop the Korean Treatment Algorithm Project for OCD 2007 (KTAP-OCD 2007). METHODS: The survey questionnaire based on the Expert Consensus Guideline Series-Obsessive Compulsive disorder (1997) and was developed through modification and review by a study group for the KTAP-OCD 2007. Twenty-four (70.6%) of the 34 members of the review committee completed the survey. RESULTS: For the initial treatment of OCD, all of the selective serotonin reuptake inhibitor (SSRI)monotherapies, cognitive-behavioral therapy (CBT), and SSRI+CBT were included in the first treatment options. Fluoxetine, sertraline, paroxetine, citalopram, and fluvoxamine were included among the available SSRIs. The treatment for resistant OCD, maintenance treatment, treatment for comorbidities, and CBT for various clinical symptoms were also evaluated by the questionnaire. DISCUSSION: Most experts presented a consensus opinion as to the initial treatment of OCD, some nonconsensual opinions were expressed and gaps occurred between research data and clinical usage in some steps. And there are some differences were seen between Western countries and Korea. The KTAP-OCD 2007 is the first algorithm developed for OCD treatment in Korea, and our hope is that the KTAP-OCD will assist clinicians and researchers.
Advisory Committees ; Ceremonial Behavior ; Citalopram ; Comorbidity ; Consensus ; Fluoxetine ; Fluvoxamine ; Hope ; Korea ; Obsessive-Compulsive Disorder* ; Paroxetine ; Surveys and Questionnaires ; Serotonin ; Sertraline

OBJECTIVETo modify the synthetic method of fluvoxamine.

METHODSFluvoxamine was synthesized from 4-trifluoromethylbenzonitrile by the steps of Grignard reaction, hydrolysis and oximation.

RESULTThe chemical structure of the synthesized product was confirmed by (1)HNMR, and the total yield reached to 36.16%.

CONCLUSIONThe results indicate that the synthetic route is practical.