Dieckmann Luiz Henrique Junqueira, Haddad Michel, Wendt Viola Thiago, Franco Scarante Franciele, Rodrigues da Silva Naielly, Mari Jair de Jesus
Department of Psychiatry, Brazilian Clinical Research Institute, São Paulo 01404-000, SP, Brazil.
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04017-030, SP, Brazil.
Pharmaceuticals (Basel). 2025 May 12;18(5):711. doi: 10.3390/ph18050711.
Depression is one of the leading causes of disability worldwide. Among pharmacological treatments, fluvoxamine-an early SSRI with a distinct pharmacological profile-has been recently reappraised for its broader clinical relevance. Objective: To assess the efficacy of fluvoxamine in the treatment of depression compared to placebo and other antidepressants through a comprehensive overview of systematic reviews and meta-analyses. Methods: A systematic search was conducted in MEDLINE and the Cochrane Central Register of Controlled Trials, including systematic reviews and meta-analyses of randomized controlled trials evaluating fluvoxamine's efficacy. Reviews were eligible if they included adults diagnosed with depressive disorders based on the DSM or ICD criteria. Reviews focusing on other psychiatric disorders, comorbidities, tolerability, or economic evaluations were excluded. Data extraction included effect size measures and methodological quality assessments using the AMSTAR-2 tool. Results were synthesized by comparing fluvoxamine to placebo, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other antidepressants. A total of 74 reviews were identified, of which 14 systematic reviews met the inclusion criteria after screening and full-text analysis. These reviews, published between 1994 and 2021, predominantly involved nine pairwise meta-analyses and five network meta-analyses, comparing fluvoxamine with placebo and various antidepressants. Fluvoxamine demonstrated consistent superiority over placebo in achieving treatment response and remission outcomes. Comparisons with imipramine, clomipramine, amitriptyline, dothiepin, paroxetine, fluoxetine, citalopram, mianserin, nortriptyline, and moclobemide generally revealed no significant differences in efficacy. However, some reviews indicated that venlafaxine and mirtazapine were superior to fluvoxamine in certain outcomes, while fluvoxamine demonstrated greater efficacy than desipramine in one review. Sertraline and milnacipran showed mixed or review-quality-dependent results, with one low-quality review favoring milnacipran. Most reviews assessed outcomes over a median follow-up of six weeks using standardized depression rating scales. Fluvoxamine is a robust and effective antidepressant, demonstrating consistent efficacy comparable to other antidepressants and superior to placebo. While no single antidepressant was universally superior, fluvoxamine's unique pharmacological profile and favourable safety characteristics support its clinical utility. Further research is needed to explore its role in personalized treatment strategies and emerging therapeutic contexts, such as comorbid anxiety and post-traumatic stress disorder.
抑郁症是全球导致残疾的主要原因之一。在药物治疗中，氟伏沙明——一种具有独特药理特性的早期选择性5-羟色胺再摄取抑制剂（SSRI）——最近因其更广泛的临床相关性而得到重新评估。目的：通过对系统评价和荟萃分析的全面综述，评估氟伏沙明与安慰剂及其他抗抑郁药相比治疗抑郁症的疗效。方法：在MEDLINE和Cochrane对照试验中央注册库中进行系统检索，包括对评估氟伏沙明疗效的随机对照试验的系统评价和荟萃分析。如果综述纳入了根据《精神疾病诊断与统计手册》（DSM）或《国际疾病分类》（ICD）标准诊断为抑郁症的成年人，则该综述符合纳入标准。排除关注其他精神障碍、合并症、耐受性或经济评估的综述。数据提取包括使用AMSTAR-2工具进行效应量测量和方法学质量评估。通过将氟伏沙明与安慰剂、三环类抗抑郁药（TCA）、选择性5-羟色胺再摄取抑制剂（SSRI）、5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）及其他抗抑郁药进行比较来综合结果。共识别出74篇综述，其中14篇系统评价经筛选和全文分析后符合纳入标准。这些综述发表于1994年至2021年之间，主要涉及9项成对荟萃分析和5项网状荟萃分析，比较了氟伏沙明与安慰剂及各种抗抑郁药。在实现治疗反应和缓解结局方面，氟伏沙明显示出优于安慰剂的一致性优势。与丙咪嗪、氯米帕明、阿米替林、多塞平、帕罗西汀、氟西汀、西酞普兰、米安色林、去甲替林和吗氯贝胺的比较总体显示疗效无显著差异。然而，一些综述表明，文拉法辛和米氮平在某些结局方面优于氟伏沙明，而在一项综述中氟伏沙明显示出比地昔帕明疗效更佳。舍曲林和米那普明显示出混合或取决于综述质量的结果，一项低质量综述支持米那普明。大多数综述使用标准化抑郁评定量表在中位随访六周时评估结局。氟伏沙明是一种强效且有效的抗抑郁药，显示出与其他抗抑郁药相当的一致疗效且优于安慰剂。虽然没有一种抗抑郁药普遍优于其他药物，但氟伏沙明独特的药理特性和良好的安全性特征支持其临床应用。需要进一步研究以探索其在个性化治疗策略以及新兴治疗背景（如合并焦虑和创伤后应激障碍）中的作用。
