NOTES ON THE USE OF FLUVOXAMINE AS TREATMENT OF DEPRESSION IN HIV-1-INFECTED SUBJECTS

Fluvoxamine belongs to the class of selective serotonin reuptake inhib itors (SSRls) which have recently gained large popularity as antidepre ssant agents essentially because they lack the most troublesome advers e effects of older antidepressants (i.e. tricyclic antidepressants) su ch as anticholinergic effects and cardiotoxicity. Recent studies in th e literature suggest that HIV-1 infected subjects are affected by depr essive episodes with a relatively high frequency, often requiring an a ntidepressant treatment. Due to its favorable adverse effects profile, we used fluvoxamine as first line treatment for sixteen depressed HIV -1 infected subjects. They were administered the drug at a daily dosag e of 100 mg in the evening. Fluvoxamine provided a good clinical effic acy for six of these patients, whereas the other ten had to discontinu e the drug because of the presence of severe adverse effects such as a cute total insomnia, gastro-intestinal disturbances together with anor exia, aggressive and impulsive behavior and excessive sedation. The ob served fluvoxamine side-effects are not typical or specific for this p articular patient group since they are also described in seronegative subjects taking fluvoxamine; however, our findings seem to indicate th at they become more frequent and more severe when the drug is administ ered to HIV-1 infected patients.