Fluvoxamine in the Treatment of Delusional Depression: a Brief Review of Clinical and Pharmacological Aspects

Review article

Fluvoxamine in the Treatment of Delusional Depression: a Brief Review of Clinical and Pharmacological Aspects

Linda Franchini

Affiliation: Department of Neuropsychiatric Sciences, School of Medicine, Universita` Vita-Salute, Istituto Scientifico H San Raffaele-Turro, Milan, Italy


ABSTRACT

The primary distinguishing feature of delusional depression is the presence of delusions or hallucinations in the context of a major depressive episode. Patients also tend to show a high severity of several depressive symptoms, including depressed mood, appetite loss, insomnia, psychomotor disturbances, fatigue, worthlessness, guilt, cognitive disturbances, hopelessness, and suicidal ideation. The prevalence of delusional depression is estimated to be about 20% in patients with depressive episodes and around 0.6% in the general population. Studies indicate that monotherapy with selective serotonin reuptake inhibitors (SSRIs) may be a generally safer, better tolerated alternative to traditional treatments for delusional depression. The most widely studied SSRI monotherapy is fluvoxamine, which has recently been shown to have potent sigma‐1 receptor agonist activity. Emerging evidence has linked the activity of sigma‐1 receptor ligands to improvement in a broad range of symptoms of mental illness, including psychosis, stress, anxiety, depression, aggression, pharmacodependence, and cognitive dysfunction. The current paper explores current pharmacological strategies for using SSRIs to improve outcomes in patients with delusional depression.

Keywords: delusional depression, fluvoxamine, selective serotonin reuptake inhibitor (SSRI), sigma-1 receptor
Correspondence: Department of Neuropsychiatric Sciences, School of Medicine, Universita` Vita-Salute, Istituto Scientifico H San Raffaele-
Turro, Via Stamira d’Ancona 20, 20127 Milan, Italy. Tel: +39-02-26433478; Fax: +39-02-26433265; e-mail: franchini.linda@hsr.it