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Luvox

Fluvoxamine (sold as Luvox®, Faverin® and Fevarin®) is a selective serotonin reuptake inhibitor. It is used primarily to treat depression, anxiety and OCD. more...

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Although its effects are similar to other SSRIs, it acts on the body's neurochemistry differently. For this reason, fluvoxamine can be of benefit to patients who experience unusual or limiting side-effects from other antidepressants. Fluvoxamine also appears to cause fewer side-effects than other SSRIs, particularly in relation to loss of sex-drive.

Fluvoxamine has the shortest half-life of all the SSRIs. Its mean serum half-life is 15 hours after a single dose, and 17 to 22 hours after repeated doses.

Fluvoxamine causes many drug-drug interactions due to inhibition of metabolism mediated by several cytochrome P450 oxidases. Examples of substances that have higher serum levels when administered together with fluvoxamine include caffeine, clozapine, olanzapine, tricyclic antidepressants, diazepam, alprazolam, propranolol, warfarin and methadone.

Effective dosage

For depression and anxiety, dosage normally starts at 50 milligrams per day, rising to 100 milligrams after a few days. It may be raised after evaluation of the effects by a doctor.

Fluvoxamine is generally only effective for OCD at 150 milligrams and above, and dosages can reach 300 milligrams or more for some patients.

Historical Relevance

In 1999, fluvoxamine came under great public scrutiny after it was discovered that Eric Harris, one of the two teenaged shooters involved in the Columbine High School massacre, had been taking the drug as treatment for depression. Many immediately pointed fingers at fluvoxamine and its manufacturer Solvay Pharmaceuticals (which sells fluvoxamine under the widely known brandname Luvox), since Solvay's own clinical trials indicated the drug had the propensity to induce "mania" in 4% of the youth who took it. Solvay, while acknowledging the risks inherent in taking an SSRI medication like fluvoxamine, downplayed any role the drug may have had in the killings. The American Psychiatric Association (A.P.A.) took a similar stance; Rodrigo Munoz, M.D., President of the A.P.A., said: "Despite a decade of research, there is little valid evidence to prove a causal relationship between the use of anti-depressant medications and destructive behavior. On the other hand, there is ample evidence that undiagnosed and untreated mental illness exacts a heavy toll on those who suffer from these disorders as well as those around them." It was also pointed out by many that Luvox was often safer than the other SSRI medications available--for example, fluoxetine (Prozac) caused mania in 6% of youth tested on the drug (versus fluvoxamine's 4%). Nonetheless, the reputation of Luvox was irreparably damaged. Sales fell, and Solvay withdrew the medication from the U.S. market in 2002; the company maintains, however, that this move had nothing to do with the safety profile of the fluvoxamine, which they still sell in many countries around the world. In the United States, fluvoxamine can only be purchased generically.

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Natural remedies for psychiatric conditions
From Townsend Letter for Doctors and Patients, 5/1/05 by Irene Alleger

Handbook of Psychotropic Herbs

by Ethan Russo, MD

The Haworth Press, Inc. 10 Alice Street, Binghampton, New York 13904 USA; 800-429-6784; sales@haworthpress.com

Softcover, 2001, $29.95, 352 pp.

In the late 1980s the selective serotonin reuptake inhibitors (SSRIs) burst upon the psychiatric landscape, and fueled by massive advertising campaigns, these new "miraculous" drugs for depression began to generate enormous profits from the ensuing parade of pharmaceuticals: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa). A major change in the treatment of psychiatric disorders came with the new drugs: family doctors began to prescribe them--to children as young as four--and today we are seeing the sequelae of suicidal ideation in young people taking these drugs, as well as aggression (most of the school shooters, such as Columbine, were taking one of the SSRIs)

Now that we know the deadly side effects of these drugs, it seems imperative to find alternatives to the SSRIs. Although many people use herbs occasionally, most are unaware of a number of well-researched herbs found to be effective in treating depression, insomnia, dementia and cognitive impairment, anxiety, and obsessive compulsive disorder (OCD). Ethan Russo, MD, author of several books on psychotropic herbs, and a well-known neurologist with vast clinical experience, has remedied this lack with the Handbook of Psychotropic Herbs.

Dr. Russo's books are solidly rooted in scientific data. His analysis of herbal remedies for psychiatric conditions includes history of usage, botany, preparation of extracts, and the newest research, making his Handbook of Psychotropic Herbs a unique and reliable resource for practitioners.

While some books have focused on herbs for specific uses (e.g. men's health, women's health, tonic herbs, etc.), Dr. Russo's book is the first compilation of scientific and clinical data solely on herbs with central nervous system (CNS) effects.

A comprehensive review of each botanical agent is given, with sound advice on the use of safe and effective herbs which are commonly found on the shelves of health food stores, mail-order catalogs, Web sites, and from health practitioners. "Dr. Russo's treatment of St. John's wort (Hypericum perforatum), is one of the most complete reviews of the clinical literature currently available ..." (from the Foreword).

Besides St. John's wort, Dr. Russo suggests 5-Hydroxytryptophan (Griffonia simplicifolia), Licorice (Glycyrrhiza glabra), and Essential Fatty Acids (EFAs) for depression.

For insomnia, the herbs recommended are Valerian (Valeriana officinalis), Passion Flower (Passiflora incarnata), German Chamomile (Matricaria recutita), Roman (English) Chamomile (Chamaemelum nobile), California Poppy (Eschscholzia californica), Hops (Humulus lupulus), Lemon Balm (Melissa officinalis), Scullcap (Scutellaria lateriflora), and Oats (Avena sativa).

The herbs for dementia and cognitive impairment are fewer: Ginkgo (Ginkgo biloba), Gotu Kola (Centella asiatica), and Huperzine (Huperzia serrata).

For anxiety, one herb: Kava-Kava (Piper methysticum).

For OCD, one herb: Marijuana (Cannabis sativa, Cannabis indica). "OCD is marked by an insurmountable preoccupation with fixed ideas, no matter how preposterous, that withstand the patient's best efforts to submerge them through the application of logic. Cannabis, as no other substance yet discovered, allows a person to forget, and to laugh, even at one's own obsessions and compulsions. For OCD, it sounds like just what the doctor ordered."

The last section of Handbook of Psychotropic Herbs consists of nine Clinical Case Studies, illustrating the efficacy of these herbs: Episodic Use of Kava; Case of Dementia Treated with Ginkgo biloba; Head Injury Treated with Ginkgo; (another) Head Injury Treated with Ginkgo; Treatment of Varied Symptoms with 5-HTP; Dementia Treated with Ginkgo; Treatment with a Variety of Herbal Agents; Managing Mania & Obsessive-Compulsive Disorder; and Cases of Treatment with Ginkgo and Kava.

Ethan Russo, MD is a child and adult neurologist at Montana Neurobehavioral Specialists, and is Board-Certified in Neurology with Special Qualification in Child Neurology. He also holds a faculty position in the Department of Pharmaceutical Sciences as an Adjunct Associate Professor at the University of Montana, where "he regularly lectures to undergraduates and graduate students in pharmacy, psychology, sports medicine, interpersonal communications, and physical therapy." For a neurologist with these credentials to advocate herbal treatment of psychiatric disorders, is a notable event. The alternatives to the SSRIs are in place--the medical community only needs the integrity to use them. In the meantime, these safe remedies are available to those who want to avoid pharmaceutical drugs.

[ILLUSTRATION OMITTED]

review by Irene Alleger

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