- Using the Antidepressant Fluvoxamine (Luvox)
- What Is Fluvoxamine
- Side effects of Fluvoxamine
- Fluvoxamine Withdrawal
- Overdose on Fluvoxamine
- Fluvoxamine’s Interactions with Other Substances
- Physical Conditions and Fluvoxamine
- Comprehensive Care
- What Is Fluvoxamine (Luvox)?
- How Does Fluvoxamine Treat Mental Health?
- Fluvoxamine Doses
- When Fluvoxamine Works
- Side Effects
- Long-Term Use of Fluvoxamine
- Is Fluvoxamine Addictive?
- Fluvoxamine Overdose
- Alternatives to Fluvoxamine
- Fluvoxamine and Addiction Treatment
- Antidepressants and Weight Gain
- Fat Pharms: Prescription for Weight Gain
- Heavy Hitters
- SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants
- How SSRIs work
- Side effects
- Use in Pregnancy and Breast Feeding
- Withdrawal effects
- Dosage and time of dose
- How long do you need to be on a medication?
- Are there problems with very long term use?
Luvox is the brand name of the prescription drug fluvoxamine, which is used to treat obsessive-compulsive disorder (OCD).
The medicine may also help treat social phobias, panic disorders, eating disorders, and depression.
Luvox is in a class of drugs known as selective serotonin reuptake inhibitor (SSRI) antidepressants, which work by targeting neurotransmitters (chemicals in the brain that may become unbalanced).
The Food and Drug Administration (FDA) first approved Luvox in 1994. It’s manufactured by ANI Pharmaceuticals, Inc.
Luvox contains a black-box warning because clinical studies have shown antidepressants may increase the risk of suicide or suicidal thoughts in children, teens, and young adults.
Your mental health may change in unexpected ways if you take antidepressants, even if you’re over age 25.
You or your caregiver should notify a doctor immediately if you experience any of the following symptoms while taking Luvox:
- New or worsening depression
- Extreme worry
- Thoughts of harming yourself
- Panic attacks
- Agitation or irritability
- Difficulty falling asleep or staying asleep
- Aggressive behaviors
- Severe restlessness
- Acting without thinking
- Frenzied, abnormal excitement
Don’t give this drug to a child under age 18 without talking to a doctor.
Before taking Luvox, tell your physician if you’re taking any of the following medicines:
- Lotronex (alosetron)
- Mellaril (thioridazine)
- Orap (pimozide)
- Rozerem (ramelteon)
- Zanaflex (tizanidine)
You shouldn’t take Luvox if you’ve taken a monoamine oxidase inhibitor (MAOI) in the past 14 days, because a dangerous drug interaction can occur.
Tell your healthcare provider if you’re taking or have taken any of the following medicines in the last two weeks:
Luvox may cause an eye condition known as angle-closure glaucoma, which could lead to vision loss. Tell your doctor right away if you experience the following symptoms:
- Eye pain
- Vision changes (such as seeing colored rings around lights)
- Swelling or redness around the eye
Tell your physician if you have or have had any of the following medical conditions before taking Luvox:
- Heart, kidney, or liver disease
- A bleeding or blood clotting disorder
- High blood pressure or a history of stroke
- Bipolar disorder
- Low levels of sodium in your blood
- Adrenal disease
Also, let your healthcare provider know if you’ve ever consumed large amounts of alcohol or used street drugs before taking Luvox.
It could take several weeks or longer before you experience the full benefits of Luvox. Continue to take the medicine even if you feel well.
Don’t stop taking Luvox without first talking to your doctor. You could experience unpleasant withdrawal symptoms if you suddenly stop using the drug.
Tell your doctor you’re taking this medicine before having any type of surgery, including a dental procedure.
Pregnancy and Luvox
Don’t start or stop taking Luvox during pregnancy without first talking with your doctor.
Let your physician know right away if you become pregnant while taking Luvox. The medicine may cause serious lung complications or other problems in newborns if it’s taken during the last months of pregnancy.
Luvox can pass into breast milk and harm a breastfeeding baby. Don’t breastfeed while taking this medicine.
Brand Names: Luvox, Luvox CR
Generic Name: fluvoxamine
- What is fluvoxamine (Luvox, Luvox CR)?
- What are the possible side effects of fluvoxamine (Luvox, Luvox CR)?
- What is the most important information I should know about fluvoxamine (Luvox, Luvox CR)?
- What should I discuss with my healthcare provider before taking fluvoxamine (Luvox, Luvox CR)?
- How should I take fluvoxamine (Luvox, Luvox CR)?
- What happens if I miss a dose (Luvox, Luvox CR)?
- What happens if I overdose (Luvox, Luvox CR)?
- What should I avoid while taking fluvoxamine (Luvox, Luvox CR)?
- What other drugs will affect fluvoxamine (Luvox, Luvox CR)?
- Where can I get more information (Luvox, Luvox CR)?
What is fluvoxamine (Luvox, Luvox CR)?
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Fluvoxamine affects chemicals in the brain that may be unbalanced in people with obsessive-compulsive symptoms.
Fluvoxamine is used to treat social anxiety disorder (social phobia), or obsessive-compulsive disorders involving recurring thoughts or actions.
Fluvoxamine may also be used for purposes not listed in this medication guide.
What are the possible side effects of fluvoxamine (Luvox, Luvox CR)?
Get emergency medical help if you have signs of an allergic reaction: skin rash, blisters, or hives; fever, joint pain; difficult breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have;
- anxiety, racing thoughts, risk-taking behavior, sleep problems (insomnia), feelings of extreme happiness or irritability;
- blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
- seizure (convulsions);
- changes in weight or appetite;
- easy bruising or unusual bleeding;
- low levels of sodium in the body–headache, confusion, memory problems, severe weakness, loss of coordination, feeling unsteady; or
- severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea
Common side effects may include:
- drowsiness, dizziness;
- shaking, feeling anxious;
- depressed mood;
- sleep problems (insomnia);
- upset stomach, gas, loss of appetite;
- nausea, vomiting, diarrhea;
- dry mouth, yawning;
- sore throat;
- muscle pain;
- sweating, rash;
- heavy menstrual periods; or
- decreased sex drive, abnormal ejaculation, trouble having an orgasm.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is the most important information I should know about fluvoxamine (Luvox, Luvox CR)?
You should not take fluvoxamine if you are also using alosetron, pimozide, ramelteon, thioridazine, or tizanidine.
Do not use fluvoxamine within 14 days before or 14 days after you have taken an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Do not stop using desvenlafaxine without first talking to your doctor.
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Before taking fluvoxamine,
- tell your doctor and pharmacist if you are allergic to fluvoxamine, any other medications, or any of the ingredients in fluvoxamine tablets and extended-release capsules. Ask your doctor or pharmacist for a list of the ingredients..
- tell your doctor if you are taking alosetron (Lotronex), astemizole (Hismanal) (not available in the U.S.), cisapride (Propulsid) (not available in the U.S.), pimozide (Orap), ramelteon (Rozerem), terfenadine (Seldane) (not available in the US), tizanidine (Zanaflex), or thioridazine. Your doctor will probably tell you not to take fluvoxamine.
- tell your doctor if you are taking the following medications or if you have stopped taking them within the past 14 days: monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue; phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). Your doctor will probably tell you not to take fluvoxamine. If you stop taking fluvoxamine, you should wait at least 14 days before you start to take an MAO inhibitor.
- tell your doctor and pharmacist what prescription and nonprescription medications, and vitamins you are taking or plan to take. Be sure to mention any of the following: alprazolam (Xanax); anticoagulants (‘blood thinners’) such as warfarin (Coumadin); aspirin or aspirin-containing products and other nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); beta-blockers such as metoprolol (Lopressor, Toprol) and propranolol (Inderal, in Inderide); buspirone (BuSpar); carbamazepine (Tegretol); clopidogrel (Plavix), clozapine (Clozaril); cyclosporine (Neoral, Sandimmune); dextromethorphan (in cough medications); diazepam (Valium); diltiazem (Cardizem); diuretics (‘water pills’); fentanyl (Abstral, Actiq, Fentora, Onsolis, others); haloperidol (Haldol); ketoconazole (Nizoral); lithium; medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig); methadone (Dolophine, Methadose); mexiletine (Mexitil); metoclopramide; midazolam (Versed); omeprazole (Prilosec, Zegerid); other medications for anxiety, depression, or mental illness; phenytoin (Dilantin);sibutramine (Meridia); tacrine (Cognex); theophylline (Theo-Dur); tramadol (Ultram, in Ultracet); triazolam (Halcion); and quinidine. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products and nutritional supplements you are taking, especially products that contain St. John’s wort and tryptophan.
- tell your doctor if you drink or have ever drunk large amounts of alcohol or have used street drugs or have overused prescription medications. Also tell your doctor if you have or have ever had seizures, or heart, kidney, adrenal, or liver disease.
- tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking fluvoxamine, call your doctor. Fluvoxamine may cause problems in newborns following delivery if it is taken during the last months of pregnancy.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking fluvoxamine.
- you should know that this medication may make you drowsy or affect your judgment, thinking, or motor skills. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication. You should not drink alcohol while taking fluvoxamine.
- tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
- you should know that fluvoxamine may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.
Using the Antidepressant Fluvoxamine (Luvox)
Fluvoxamine is a generic drug, found primarily under the brand name Luvox, which is prescribed to treat obsessive-compulsive disorder. Occasionally, it is prescribed off label to treat panic disorders, social phobias, depression, and eating disorders. This antidepressant is in the class of selective serotonin reuptake inhibitors (SSRIs).
What Is Fluvoxamine
As an SSRI, fluvoxamine increases the amount of serotonin the brain releases and reduces how fast neurotransmitter receptors uptake the chemical. When there is more serotonin present in the brain, mood stabilizes, and the person feels less depressed.
Luvox was originally approved by the Food and Drug Administration (FDA) in 1994. ANI Pharmaceuticals, Inc. manufactures this antidepressant.
The brand name drug Luvox comes in as either a tablet or an extended-release capsule. Tablets can be taken either once or twice daily, while the extended-release capsule is usually only taken once per day. Tablet doses are 25 mg, 50 mg, or 100 mg; capsule doses are either 100 mg or 150 mg. A prescription dose typically begins at 50 mg per day but can increase to as much as 300 mg, if needed. Doses are adjusted depending on what condition the psychiatrist or physician prescribed fluvoxamine to treat. Do not adjust daily dose without consulting a medical professional.
It can take several weeks for a person to get the full benefit of fluvoxamine. It is important to continue taking the dose and report any changes to the overseeing therapist or physician.
Side effects of Fluvoxamine
There are several potential side effects of taking fluvoxamine. Most of these are not serious. They can include:
- Difficulty concentrating
- Drowsiness, sleepiness, or fatigue
- Constipation, gas, nausea, vomiting, or diarrhea
- Other stomach pain
- Dry mouth
- Changes in weight due to appetite changes
- Changes in the taste of food or drink
- Physical weakness
- Anxiety or nervousness
- Changes in sex drive
- Unsteady balance
Fluvoxamine can cause some serious side effects. These should be reported to a doctor immediately. They can include:
- Chest pain
- Severe dizziness
- Loss of coordination
- Irregular or rapid heartbeat
- Muscle stiffness and pain
- Tingling, burning, or numbness, especially in the extremities
- Rash, hives, or other sign of an allergic reaction
- Reduced or difficult breathing
- Uncontrollable shaking, especially in one part of the body
- Loss of consciousness
- Bloody, tar-like, or black stools
- Vomit that looks like coffee grounds
As with other SSRIs, one of the potential serious side effects of fluvoxamine is increased suicidal thinking or self-harming actions. People who are 24 years old or younger are particularly at risk of developing this rare condition, but it can occur in people over 24 years old as well. This is a symptom that the medication is affecting brain chemistry in unintended ways, so it is important to consult a doctor immediately. People who take fluvoxamine should also consult a doctor if mood does not improve after a month of regular use.
Other serious side effects of fluvoxamine include:
- Recurring depression or worsening depression
- Intense worry or anxiety
- Panic attacks
- Agitation, irritability, or mood swings
- Severe restlessness
- Impulsive behaviors
- Abnormal excitement
Because fluvoxamine changes brain chemistry, the brain can become dependent on this medication to moderate serotonin and other neurotransmitters. If a person stops taking their fluvoxamine prescription suddenly, they could experience withdrawal symptoms due to the body’s dependence on this medication. It is important for a person to discuss ending the prescription with their doctor if they do not want to take this medication anymore. The doctor can work with the person on a taper to ease the body off dependence on the medication.
Overdose on Fluvoxamine
Although it is difficult to overdose on fluvoxamine, it is possible. Symptoms of fluvoxamine overdose include:
- Enlarged pupils
- Loss of coordination or balance
- Extreme drowsiness
- Nausea, vomiting, or diarrhea
- Changes in alertness
- Changes in heartbeat, either faster or slower
- Trouble breathing
- Uncontrollable shaking, especially in just one part of the body
- Loss of consciousness
It is extremely important for a person experiencing an overdose to get immediate medical attention. Always call 911 immediately if witnessing a person overdosing on any medication.
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Fluvoxamine’s Interactions with Other Substances
Since fluvoxamine changes the balance of neurotransmitters in the brain, it can interact with other prescription, over-the-counter, or recreational drugs. Some of these include:
- Blood thinners
- Beta blockers
- Dextromethorphan, which is found in cough syrups
- Narcotic painkillers
- Migraine medications
- Medications for heart burn, acid reflux, or GERD
- Dietary supplements like St. John’s wort or tryptophan
Both alcohol and tobacco can interact with fluvoxamine. Some of the side effects associated with fluvoxamine can get worse when combined with alcohol. Smoking cigarettes or consuming other tobacco products may decrease fluvoxamine’s effectiveness.
It is also important not to take SSRIs or other antidepressants together. This can lead to serotonin syndrome, which can cause seizures, hallucinations, and other serious health issues. People who have taken an antidepressant before but are switching to fluvoxamine should speak with their doctor about an appropriate length of time to detox from the previous antidepressant, so the medications do not negatively impact each other.
Physical Conditions and Fluvoxamine
Some medical conditions can interact with fluvoxamine. These include:
- Cardiovascular problems
- Kidney or liver disease
- History of strokes
- High blood pressure
- Bipolar disorder
- Low sodium in the blood
- Adrenal disease
Women who are breastfeeding, pregnant, or planning to become pregnant should speak with their doctor about fluvoxamine’s potential effects on the fetus or infant. There is a less than 1 percent chance of birth defects or premature birth, usually related to the woman taking fluvoxamine in the third trimester. However, the woman and her physician must weigh the risks of stopping an antidepressant with the risk of depression during pregnancy or postpartum depression. Ultimately, the decision is made between the woman and her doctor.
People who struggle with mental health conditions, such as obsessive-compulsive disorder, bipolar disorder, anxiety, and depression, are more likely to develop difficulties with substance abuse. Fortunately, it is very possible to overcome an addiction and manage a mental health disorder at the same time. Medically supervised detox can end the body’s dependence on intoxicating substances, while a comprehensive rehabilitation program provides therapy and social support to help the individual manage mental health issues and maintain sobriety.
What Is Fluvoxamine (Luvox)?
Fluvoxamine is the generic name for a selective serotonin reuptake inhibitor (SSRI), sold most often under the brand name Luvox.
Although fluvoxamine is a drug in the same class as several antidepressants, like Celexa (citalopram), this medication is prescribed primarily to treat obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD). It is sometimes prescribed to treat depression, panic disorders, and eating disorders like bulimia. Fluvoxamine may be prescribed off label to treat irritable bowel syndrome (IBS), post-traumatic stress disorder (PTSD), generalized anxiety disorder, or agoraphobia.
How Does Fluvoxamine Treat Mental Health?
SSRIs like fluvoxamine inhibit the ability of receptors to rapidly reabsorb serotonin, allowing the neurotransmitter to affect communication between neurons for longer. Serotonin is associated with mood changes, and when the brain lacks the neurotransmitter, the person can suffer low moods associated with depression or struggle with other issues such as anxiety. By increasing serotonin’s lifespan and increasing the ability of neurons to communicate for longer, SSRI antidepressants improve mood and energy.
Like other SSRI antidepressants, fluvoxamine does not take full effect immediately; instead, it can take several weeks for the drug to fully effect serotonin levels in the brain, so a person taking this prescription must be patient.
The most common form of fluvoxamine is an extended-release tablet, which is taken orally either once or twice per day, depending on how high the individual’s dose needs to be to receive a benefit from their medication. It is important for any person with a fluvoxamine prescription not to take more than 300 mg of this medication per day, as doing so can cause overdose. Capsules can also be found; doses for tablets are 25 mg, 50 mg, and 100 mg, while capsules come in 100 mg and 150 mg forms.
Dosing depends on the condition fluvoxamine is prescribed to treat, but doses can range from 50 mg per day to no more than 300 mg per day. People taking this medication to treat OCD, for example, start at 100 mg once per day, then work with their therapist to adjust the dose as needed.
When Fluvoxamine Works
When a person receives a prescription for fluvoxamine, the intention is for the medication to be part of the larger treatment plan to overcome a mental health condition, like OCD, an eating disorder, an addiction, or a mood disorder. A full treatment plan for any mental health condition includes working with a therapist on long-term understanding of the issue. Medications like fluvoxamine could be taken for years, as long as they continue to treat symptoms; however, relief from symptoms is supposed to help the person understand their mental health with the help of a therapist. Medication alone is not a treatment for mental health problems.
There is some indication that fluvoxamine can aid in treating addictions, including alcohol use disorder or narcotics abuse. The SSRI may also be a good treatment for compulsive disorders like compulsive buying. However, the medication may work in this way because there is an underlying mood disorder or OCD leading to substance abuse or compulsion.
Like any medication, a person taking fluvoxamine may experience side effects. At normal doses, these are less likely; however, some may occur over time, or a person could experience side effects if they are taking a dose that is higher than they need. If these symptoms occur, a doctor or therapist can adjust the medication to a level where side effects are not distracting or uncomfortable, or the physician may switch their patient to a different medication, which may work better and produce fewer side effects.
Side effects associated with fluvoxamine include:
- Trouble concentrating
- Difficulty with memory
- Dry mouth
- Nausea or vomiting
- Stomach pain
- Changes to the taste of food
- Appetite changes, especially decreased appetite
- Weight changes, especially weight loss
- Changes in sex drive, particularly reduced sex drive
Fluvoxamine may cause an allergic reaction in some people, so if the drug produces hives, rash, trouble breathing, uncontrollable shaking, or unusual bleeding, then it is important to contact 911 immediately.
SSRIs like fluvoxamine may also cause suicidal ideation, especially in people under the age of 24. While this is a paradoxical effect, as the medication should improve mood, in some young people, the medication can lead to increased morbid thoughts, thoughts about death and dying, thinking about one’s own death, or planning one’s death. It is important to speak with a doctor if these thoughts or obsessions occur, as this indicates that the dose should be adjusted or the person should switch medications.
There is a small concern about aggression and SSRIs like fluvoxamine. TIME Magazine published a blog noting that fluvoxamine was among the top 10 legal prescription medications associated with an increased risk of violence and aggression. One of the shooters in the Columbine High School massacre in 1999 was taking fluvoxamine.
Long-Term Use of Fluvoxamine
While a person taking fluvoxamine may develop a dependence on the medication, as well as a tolerance to the drug, there are no other recorded long-term effects associated with the drug. People who have heart problems, liver damage, or kidney disease should consult their doctor before taking the medication, as fluvoxamine may make these conditions worse when prescribed at average levels.
Is Fluvoxamine Addictive?
Fluvoxamine is not believed to be addictive, in part because it has no immediate euphoric effects on the brain, unlike other psychiatric medications such as benzodiazepines. Although people who struggle with substance abuse disorders may attempt to abuse prescription medications like fluvoxamine, there is no indication that the risk of addiction and abuse is high.
While Luvox and other fluvoxamine medications are not believed to be addictive, the medication does adjust brain chemistry, and the body typically develops dependence on it over time. Physical dependence occurs when the brain requires the presence of a substance to stimulate production or uptake of chemicals like neurotransmitters. When a person is dependent on a substance, then suddenly stops taking it, they can experience withdrawal symptoms.
Dependence can be associated with addiction. For example, people who become addicted to opioids or alcohol also develop physical dependence on the drug. However, it is not the only indication of addiction, and dependence can occur when a person takes medication as prescribed but is not addicted to the substance.
Withdrawal symptoms for fluvoxamine include:
- Mood swings
- Agitation or aggression
- Intense worry or anxiety
- Feeling uneasy
- Exhaustion or fatigue
- Trouble falling or staying asleep
- Pain, burning, or numbness in the hands and feet
- Feelings like an electric shock in the extremities
If a person takes fluvoxamine as prescribed but wants to stop taking it, the individual should discuss this change in medication with their doctor or therapist. The medical professional will devise a tapering regimen to help their patient gradually end their physical dependence on the medication, which helps to avoid the most intense withdrawal symptoms.
It is difficult to overdose on SSRI medications like fluvoxamine because the drugs do not lend themselves to abuse or addiction. However, if a person is taking other antidepressant medications, including other SSRI drugs, MAO inhibitors, or tricyclic antidepressants, the combination of medications could cause serious side effects, and an overdose effect known as serotonin syndrome. When a person takes large doses of drugs that interact with serotonin, it can lead to too much of the neurotransmitter accumulating in the brain. Symptoms of serotonin syndrome include:
- Restlessness or agitation
- Extreme confusion
- High blood pressure
- Rapid heart rate
- Dilated pupils
- Loss of physical coordination or muscle strength
- Muscle rigidity
- Sweating profusely
Symptoms typically begin within several hours of taking medications that cause serotonin syndrome. Mild serotonin syndrome may go away within a few days, especially if the person contacts their doctor and takes a medication to temporarily block the SSRIs or other antidepressants. However, severe serotonin syndrome can be dangerous or even fatal. Symptoms that require emergency medical attention include:
- Irregular heartbeat
- High fever
- Falling unconscious
Alternatives to Fluvoxamine
If fluvoxamine does not work to treat a specific condition, there may be other medical alternatives. For example, there are many other SSRI medications available, and one of those may work better to moderate mood or other issues.
Not all SSRIs are good for treating OCD. Although fluvoxamine is among those that work well, other SSRIs that are successful at treating symptoms of OCD include Zoloft, Prozac, Effexor, Celexa, and Lexapro. Additionally, Anafranil (clomipramine) has been studied thoroughly and is often prescribed to treat OCD. This medication is specifically designed to treat compulsive disorders.
Antidepressants, including SSRIs, tricyclic antidepressants, and some MAO inhibitors, are currently considered the best long-term medical treatment for anxiety and panic disorders. However, people who have acute anxiety, including sudden panic attacks, may instead choose to take benzodiazepines like Klonopin or Xanax as needed or for a short time. It is important not to take benzodiazepines regularly for more than two weeks, as these substances quickly lead to physical dependence and potential addiction; however, for very short-term treatment of serious anxiety symptoms, they work well.
Fluvoxamine and Addiction Treatment
This antidepressant may be used as part of a larger treatment plan to address a mental health condition associated with addiction. When an addiction and mental health problem occur together, they are called co-occurring disorders. People who struggle with one disorder are more likely to struggle with the other: for example, people who suffer anxiety may attempt to self-medicate with CNS depressants like alcohol, or alcohol use disorder could contribute to a mood disorder. It is important for both conditions to be treated simultaneously during rehabilitation.
As the link between addiction and mental health is better understood, rehabilitation programs are better able to treat these conditions. Treatment may include prescription medications like fluvoxamine, which help stabilize mood. Medications should always be used in conjunction with therapy.
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Antidepressants and Weight Gain
Many individuals have the experience of weight gain while receiving treatment with an antidepressant, and often wonder if selective serotonin reuptake inhibitors (SSRIs) are associated with weight gain. This is an excellent, complex, and clinically important question.
Depression, anxiety, appetite, and weight: There is a relationship between appetite and depression, with changes in appetite representing a core symptom of major depressive disorder. Many individuals with anxiety disorders also note appetite changes when their anxiety symptoms are not well controlled. Some individuals lose weight when they are experiencing depression or anxiety, and some notice increased appetite and weight gain. Therefore, at the time of starting an antidepressant, some individuals may be at either a lower or higher weight than they would be at in the absence of a mood or anxiety disorder.
Drugs with known weight gain: Some medications used commonly in psychiatry have well established side effects of weight changes. For example, valproic acid, some of the atypical antipsychotic medications, lithium, the antidepressant mirtazapine (Remeron), and tricyclic antidepressants are associated with weight gain. There has been little systematic long-term data regarding weight effects of SSRI antidepressants (which include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and fluvoxamine (Luvox), and the SNRIs venlafaxine (Effexor) and duloxetine (Cymbalta), although some studies suggest weight gain may occur and may vary by gender, specific medication, and other patient variables. Bupropion (Wellbutrin) is usually considered weight neutral.
Whether or not a study was short- or long-term – or clinically how long a patient has been on a medication – may influence the likelihood of weight changes. A recent meta-analysis assessed studies with available data (Serretti and Mandelli, 2010). In acute studies (4-12 weeks duration), most SSRIs, SNRIs, and bupropion have been associated with weight loss. In longer term studies (longer than four months), most antidepressant medications with available data did not have significantly associated weight gain, and the most was seen with paroxetine and the older antidepressant amitriptyline (mean weight gain about 5-6 lbs). Only bupropion was associated with significant weight loss (about 4 lbs).
SSRIs: Data that inform risk of weight gain and how specific medications compare to each other
There have been a few studies to provide head-to-head comparisons of weight gain amongst those treated with specific SSRIs. For example, Fava and colleages (2000) completed a study in which patients with major depression were randomly assigned to either fluoxetine, sertraline, or paroxetine. Only those that completed the 26-32 week trial were included in the final analysis of weight gain. Those who received paroxetine experienced a statistically significant weight gain from baseline to end point. Those who received fluoxetine had a trend for weight loss (not statistically significant), and those who received sertraline had a trend for moderate weight gain (not statistically significant).
Those that received paroxetine were also significantly more likely than those who received fluoxetine or sertraline to gain >7% of their original body weight, the threshold used in many studies to indicate clinically important weight gain. Mean percent changes in weight from the beginning of the study to the end were: 0.2% weight loss with fluoxetine, 1% weight gain with sertraline, and 3.6% weight increase with paroxetine. Therefore, if the typical participant weighted 150 lbs, the weight gain would be about 5.4 lbs with paroxetine and 1.5 lbs with sertraline, and the weight loss would be less than 1 pound with fluoxetine. While these are overall modest differences from the baseline weights, they are means, so some individual patients could certainly have had very different experiences than the mean.
In another study (Maina 2004), researchers assessed patients in an anxiety disorder clinic for weight changes with the tricyclic antidepressant clomipramine or SSRIs over a 2.5 year period. The group included 138 patients with obsessive compulsive disorder. They were not randomly assigned to medication. On average, the patients as a group gained 2.5% of their baseline weight (1.58 kg or 3.5 pounds over 2.5 years of treatment). 14.5% of the sample gained >7% of their initial body weight. For all medications except fluoxetine, which did not have significant weight gain, the others (clomipramine, citalopram, fluvoxamine, paroxetine, and sertraline) were associated with statistically significant weight gain over the 2.5 year duration of study. Clomipramine had the greatest percentile of patients who gained >7% of body weight, while fluoxetine and sertraline had the lowest. Women were more likely to gain weight than men.
Wisner and colleagues (2005) specifically looked at the weight impact of treatment with nortriptyline, sertraline, or placebo in women with histories of postpartum depression (PPD) who took medication after childbirth to prevent having PPD again. Mean weights after 17 weeks of treatment were not significantly different between the treatment groups. On average, women lost about 1.8 pounds over the course of the study. Because the study was a depression prevention study, women were not experiencing depression at the time of study entry, so the treatment of depressive symptoms would not be a driving factor for weight change.
The Bottom Line
Antidepressant medications can potentially contribute to weight gain, and certain antidepressants may carry a higher risk. Specifically among SSRIs, from these studies data suggest paroxetine carries the highest risk of weight gain and fluoxetine the lowest risk in the class. Additionally, recovery from depression and anxiety disorders may also contribute to increased appetite and weight. Not everyone will experience the same benefits or side effects to specific drugs. If over time, weight gain occurs and it appears that the antidepressant appear to be a major contributor to weight gain, one might consider switching to another medication or non-pharmacologic treatments.
Marlene Freeman, MD
Serretti A & Mandelli L. Antidepressants and Body Weight: A Comprehensive Review and Meta-Analysis. J Clin Psychiatry 2010;71(10):1259–1272.
Wisner et al. Weight changes in postpartum women with remitted depression. J Clin Psychiatry. 2005; 66(3):291-3.
Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000; 61(11):863-7.
Maina G, Albert U, Salvi V, Bogetto F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004; 65(10):1365-71.
Fat Pharms: Prescription for Weight Gain
The stress of working at a turbulent office finally dragged 37-year-old Maggie Little* under. For the second time in her life, she recognized the smothering symptoms of depression—slowness, a bleak outlook and lack of interest in fun. Her doctor prescribed Lexapro, a selective serotonin reuptake inhibitor, or SSRI.
The pill quickly kicked in. It was “a miracle,” she says. Six months later, Little still loves Lexapro, but she’s desperate to switch to another drug. Like many people using SSRIs, she gained a significant amount of weight—40 pounds.
Weight gain has long been a bane of psychotropic drug treatment. Mood stabilizers such as Lithium and Clozapine are among the worst offenders, causing up to 50 percent of all long-term users to become obese. Patients on older tricyclic antidepressants can expect a steady gain of one to three pounds per month. But the medical community was caught off guard when patients on newer antidepressants complained the pounds were piling on.
If anything, says Charles Raison, a psychiatrist with Emory University in Atlanta, drugs such as Prozac and Zoloft were believed to cause weight loss. Indeed, many antidepressants seem to be associated with an initial small loss, but studies show that over months, patients not only regain what they lose, but add to it—sometimes dramatically. “It’s not always the fault of the drug,” says Raison. “Depression can be, all by itself, an incredible diet. When start to feel better again, their appetite increases.”
The metabolic pathway at work is a mystery, although current theories include resistance to the hormones insulin and leptin. One study found that those most vulnerable to antidepressant-induced weight gain are women and patients who were already overweight. On the bright side, gaining some extra padding is usually linked to the drug’s efficacy. “A few extra pounds usually means the drug is doing something,” says Raison. But he says many of his patients would rather be sad than fat.
Exercise and diet can help, of course. The drug orlistat, or Xenical, which blocks the body’s ability to absorb dietary fat, also shows promise. Switching drugs may also provide some relief.
These popular drugs are likely to cause weight gain:
- Paxil (paroxetine)
- Marplan (isocarboxazid)
- Lexapro (escitalopram)
Weight neutral for most:
- Prozac (fluoxetine)
- Luvox (fluvoxamine)
- Zoloft (sertraline)
- Celexa (citalopram)
- Wellbutrin (buproprion)
*Name has been changed
SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants
There are a number of different SSRI antidepressants.
|Brand name||Chemical name|
How SSRIs work
Serotonin is a neurotransmitter made by the cells in the brain. Neurotransmitters are chemicals used by brain cells to connect and communicate with each other. SSRI antidepressants slow the rate that the brain breaks down serotonin. This in turn causes an increase in serotonin activity in the brain. This has been shown to improve symptoms of depression.
Common side effects include:
- mild nausea and vague headache which usually clear after a few days of use
- diarrhoea and abdominal cramping pain
- agitation and physical restlessness
- reduced sex drive and difficulty reaching an orgasm
The effect on weight is unclear.
- appetite reduction and weight loss most likely with fluoxetine.
- possible weight gain with some other SSRIs.
- SSRIs have been used to treat bulimia (compulsive eating).
The effect on sleep is unpredictable.
- Broken sleep is common with some of the SSRI medications (Fluoxetine (Prozac/Lovan).
- Other SSRIs may cause sleepiness (Fluvoxamine (Luvox))
- SSRIs may cause intensified dreaming.
Interactions with other drugs that affect serotonin can cause a serotonin syndrome. This syndrome involves fever, muscle shakes and seizures. It can be extremely serious and has caused deaths. Another serious problem that can occur is lowered sodium (salt) in the blood.
If changing between medications be careful that the overlap of medications does not cause too much serotonin activity. Fluoxetine leaves the body slowly and may exert its effect for more than three days.
SSRIs are usually safe. Overdose causes nausea and drowsiness. Deaths have been reported with very large overdoses.
Interactions with other drugs
Apart from the serotonin syndrome, some of the SSRI antidepressants slow the rate at which the body breaks down other medications. This may raise levels of medications such as:
- Tricyclic antidepressants
- Beta-blockers (used for high blood pressure),
- Terfenadine (Teldane)
- Sumatriptan (migraine treatment)
- Warfarin (anti-clotting medication)
It may be necessary to adjust the dose of other medications when a person is taking an SSRI.
When SSRIs must not be taken
SSRIs must not be taken at the same time as or soon after using Monoamine-oxidase inhibiting drugs (Parnate and Nardil).
Use in Pregnancy and Breast Feeding
There are no scientific studies of the effect of SSRIs on the human foetus. Animal studies show adverse effects at high doses. SSRIs should be used in pregnancy only if this is necessary for the health of the mother. SSRI antidepressants appear in breast milk. It is estimated that the fully breast-fed baby will get around 1/300th of the mother’s dose.
Antidepressants are not addictive. However, you may experience some withdrawal effects on stopping your antidepressant. Reactions vary between medications and between people. All SSRIs have been reported to produce some withdrawal effects – physical discomfort, restlessness and flu-like symptoms – if suddenly stopped. These symptoms are reduced by stopping the medication gradually (over 2 weeks from higher doses). Don’t stop taking your medication without seeing a doctor first.
Dosage and time of dose
Often the starting dose does not need to be increased. However, sometimes higher doses are needed. Some people break down the medications faster than others and need higher doses.
Tablets are usually taken in the morning as many people find later doses interfere with sleep. However, this is very variable and some people find the medications make them sleepy and, so take them at night. The time of day does not change the effectiveness of the medication.
Food does not affect absorption so medication can be taken before or after food.
If a dose is missed, take it as soon as possible. If a night-time dose is missed do not take it in the morning but take only the ordinary night-time dose the next night.
|Name||Chemical name||Common dose*||Most common time of dose|
|Prozac||Fluoxetine||20 mgm – 80 mgm||Morning|
|Lovan||Fluoxetine||20 mgm – 80 mgm||Morning|
|Zoloft||Sertraline||50 mgm – 300 mgm||Morning|
|Aropax||Paroxetine||20 mgm – 80 mgm||Morning|
|Cipramil||Citalopram||20 mgm – 80 mgm||Morning|
|Luvox||Fluvoxamine||100 mgm – 300 mgm||Evening|
|* with careful observation these doses may be considerably increased by your doctor|
How long do you need to be on a medication?
You will need to take the antidepressant for at least 6 to 9 months after your symptoms disappear. Stopping your antidepressant too early increases your chances of suffering a recurrence of depression.
Are there problems with very long term use?
SSRIs have been in use for more than 10 years. Some people have taken them for that length of time. No extra problems have emerged beyond the common side effects mentioned above.
Last reviewed and updated: 1 February 2006