BIOLOGICAL DISSECTION OF ANXIETY DISORDERS - THE CLINICAL ROLE OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS WITH PARTICULAR REFERENCE TO FLUVOXAMINE

The selective serotonin reuptake inhibitor (SSRI) fluvoxamine has been used in an attempt to understand whether there is a biological distin ction among anxiety disorders. A comparison of fluvoxamine with the sp ecific noradrenaline reuptake inhibitor maprotiline in patients with p anic disorder showed fluvoxamine to be a potent anti-panic agent, wher eas maprotiline had no effect on the frequency of panic attacks, This result supported the hypothesis of serotonergic involvement in the pat hogenesis of panic disorder, In a second study, unlike fluvoxamine, th e 5-HT2A/2C antagonist ritanserin had no effect on the number of panic attacks, or phobic avoidance, This suggested that the efficacy of ant idepressants in panic disorder was not a result of downregulation of p ostsynaptic 5-HT2 receptors, Most studies suggest that the efficacy of antidepressants in obsessive-compulsive disorder (OCD) is not related to their antidepressant or mood-enhancing effects, Fluvoxamine has al so been shown to reduce general and phobic anxiety in social phobia pa tients, In conclusion, serotonergic systems are implicated in the path ophysiology of global anxiety irrespective of the nosological backgrou nd, and SSRIs, exemplified by fluvoxamine, appear to be effective in p anic disorder, OCD and probably also social phobia.