Notes on the use of fluvoxamine as treatment of depression in HIV-1-infected subjects

Fluvoxamine belongs to the class of selective serotonin reuptake inhibitors (SSRIs) which have recently gained large popularity as antidepressant agents essentially because they lack the most troublesome adverse effects of older antidepressants (i.e. tricyclic antidepressants) such as anticholinergic effects and cardiotoxicity. Recent studies in the literature suggest that HIV-1 infected subjects are affected by depressive episodes with a relatively high frequency, often requiring an antidepressant 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 dosage of 100 mg in the evening. Fluvoxamine provided a good clinical efficacy for six of these patients, whereas the other ten had to discontinue the drug because of the presence of severe adverse effects such as acute total insomnia, gastro-intestinal disturbances together with anorexia, aggressive and impulsive behavior and excessive sedation. The observed fluvoxamine side-effects are not typical or specific for this particular patient group since they are also described in seronegative subjects taking fluvoxamine; however, our findings seem to indicate that they become more frequent and more severe when the drug is administered to HIV-1 infected patients.