Old Drug Provides New Hope for Some Mental Illnesses
Pfeiffer, Naomi, Drug Topics
When it comes to treating anxiety and related disorders, one drug, it is being claimed, may fit virtually all of them. At a recent press briefing, U.S. experts led by Steven E. Hyman, M.D., director, National Institute of Mental Health, offered compelling evidence of the effectiveness of fluvoxamine maleate (Luvox, Solvay), a serotonin uptake inhibitor, in helping patients with a wide range of mental illnesses from panic disorder to compulsive gambling-and even autism. The Food & Drug Administration approved the drug four years ago to treat obsessive-compulsive disorder (OCD). Researchers then tested it for a variety of stubborn anxiety disorders. "More than 23 million Americans suffer from major anxiety that affects their functioning," said Hyman. "The estimated annual cost is now close to $50 billion." He and his colleagues presented reports at an American Medical Association briefing in New York City recently. They emphasized the need to look at mental disorders as dysfunctions of an organ-the brainjust like any other organ dysfunction. The symptoms are "real, diagnosable, and treatable," he noted. "They are medical, not signs of weakness of character." Modern technology, such as neuroimaging and magnetic resonance imaging, can show the abnormal circuitry in the brain that underlies OCD, post-traumatic stress disorder, panic disorders, phobias, and other mental ills, he added.
"Genes make some of us vulnerable, then other environmental factors trigger different kinds of nervous system responses," he said. "In post-traumatic stress disorder, for example, symptoms such as rage and paralyzing horror may persist, brought out by ordinary incidents acting as reminders of the original trauma." What all these ailments seem to share, the panelists stressed, is malfunction of the serotonin mechanism in the brain.
David A. Spiegel, medical director, Center for Anxiety & Related Disorders, Boston University, said he believes the disturbance afflicts some five million Americans. He reported on his research group's eight-week study of fluvoxamine therapy for panic disorder complicated by depression (J. Clin Psychiatry 1996;57 [suppl 8] 37-41). Dosage began at 50 mg/day and very gradually increased to the maximum dose of 300 mg/day. The investigators found the drug "highly effective" for all components of panic disorder, except for agoraphobia, which responded later, he said, when the drug was combined with "exposure therapy"-behavior modification in which the patient is taught to reenter the feared site and see that he can handle it. In fact, said Spiegel, preliminary results from an ongoing treatment study of 300 patients suggest the best way to treat panic disorder is through a combined regimen of cognitive-behavioral therapy, which may include exposure techniques, plus selective serotonin reuptake inhibitors (SSRls). …