A review of fluvoxamine and its uses in depression.

Fluvoxamine is a potent and specific 5-HT reuptake inhibitor which has been available since 1983 and is estimated to have been given to two and a half million patients since it was first investigated in patients with depression in the late 1970s. The effectiveness of fluvoxamine in depression is therefore analysed in this review, on the basis of ten years experience. Results from 10 international double-blind placebo-controlled trials, the large majority of which included a positive control (usually imipramine), have shown that fluvoxamine is as effective as the older tricyclic antidepressants and significantly more effective than placebo. In the majority of twenty direct comparative studies against other antidepressants, fluvoxamine has been found to be as effective and well-tolerated as the reference drug. Effectiveness in the elderly depressed and support for the use of fluvoxamine in tricyclic-resistant depression is discussed. Clinical trials of fluvoxamine conducted in anxiety states and obsessive-compulsive disorder, both of which commonly co-occur with depression, are reviewed, and the efficacy of fluvoxamine in the depressed obese and patients with bulimia nervosa is examined. Reports of adverse experiences, both from clinical trials and clinical practice are discussed, and the overall risk-benefit for fluvoxamine treatment in depression is critically assessed.