EMERGENCE OF DEPRESSIVE SYMPTOMS DURING TREATMENT FOR PANIC DISORDER WITH SPECIFIC 5-HYDROXYTRYPTOPHAN REUPTAKE INHIBITORS

Selective serotonin reuptake inhibitors (SSRI) have been established a s effective drugs in the treatment of depressive and anxiety disorders . However, there are also reports that they can induce depressive symp toms and suicidal thoughts in patients. Eighty of 230 patients who met the DSM-III-R criteria for panic disorder received, during the course of treatment, fluvoxamine (a selective serotonin reuptake inhibitor) at a dose level between 50-200 mg/day. The patients were clinically ev aluated for a history of affective disorder and for the presence of af fective symptoms before the treatment and for emergence of depressive symptoms during the treatment. Seven of the 80 patients (9%) developed symptoms of depression despite a good antianxiety response. Five of t he 7 patients received fluvoxamine as second choice after tricyclic an tidepressants (TCA). These patients had no history of affective disord er, and no symptoms of depression were present before the treatment wi th fluvoxamine. The depressive symptoms abated after the fluvoxamine w as discontinued and TCA or clonazepam was prescribed. The depressive s ymptoms reappeared when fluoxetine was administered. None of these 7 p atients developed depressive symptoms while treated with TCA or clonaz epam. Among the 150 patients treated with TCA and benzodiazepines, not a single case of depression was seen in patients without a previous h istory of depression. These results suggest a vulnerability among some of panic disorder patients to noradrenergic-serotonergic imbalance ca used by SSRI, which has to be taken into clinical consideration.