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Efficacy, tolerability and side-effect profile of fluvoxamine for major depression: meta-analysis

Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan mmds{at}sannet.ne.jp

N Watanabe

Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

A Nakagawa

Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan

T Akechi

Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

A Cipriani

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy

C Barbui

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy

H McGuire

Health Service and Population Research Department, Section of Evidence-Based Mental Health, Institute of Psychiatry, King’s College London, London, UK

R Churchill

Health Service and Population Research Department, Section of Evidence-Based Mental Health, Institute of Psychiatry, King’s College London, London, UK

TA Furukawa

Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

Abstract

Fluvoxamine, one of the oldest selective serotonin reuptaking inhibitors, is commonly prescribed to patients with major depression. Several studies have reviewed the efficacy and tolerability of fluvoxamine for the treatment of major depression. However, these reviews are outdated, have not been systematic and/or suffered from several methodological weaknesses. We conducted a systematic review to synthesize the best available evidence on the efficacy of fluvoxamine for adult patients suffering from major depression in comparison with other active antidepressive agents. Relevant randomized controlled trials were identified through a comprehensive search. The primary outcome was a relative risk of response, and the secondary outcome was a relative risk of remission. Tolerability and side-effect profile were also examined. Fifty-three trials were included. There were no large differences between fluvoxamine and any other antidepressants in terms of efficacy and tolerability. There is evidence of differing side effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclics. Clinicians should focus on practically or clinically relevant differences including those in side-effect profiles.

Key Words: fluvoxamine • antidepressive agents • major depressive disorder • meta-analysis

This version was published on July 1, 2009

Journal of Psychopharmacology, Vol. 23, No. 5, 539-550 (2009)
DOI: 10.1177/0269881108089876


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