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Fluvoxamine CR is a Safe and Effective Maintenance Therapy for Generalised Social Anxiety Disorder

Fluvoxamine CR remains safe and effective extended therapy in patients with generalised social anxiety disorder (GSAD), according to a recent multicentre study.

Selective serotonin reuptake inhibitors (SSRIs) are the preferred treatment for SAD. SSRIs are also recommended for maintenance therapy; though little data are available from long-term pharmacotherapy trials. This information is particularly important since SAD is a chronic disorder.

Dan J. Stein, with University of Stellenbosch, Cape Town, South Africa, and the University of Florida, Gainesville, FL, United States, and colleagues evaluated the safety and efficacy of the SSRI fluvoxamine CR in the long term treatment of SAD.

The double-blind study included 112 patients with GSAD who showed at least minimal improvement after 12 week fluvoxamine treatment. Patients were randomised to receive fluvoxamine (100-300 mg/day) or placebo for an additional 12 weeks. Efficacy and safety were observed throughout treatment.

Further, yet slight improvement was observed with extended fluvoxamine treatment but none of the efficacy parameters reached statistical significance.

Greater decreases were seen in Liebowitz Social Anxiety Disorder Scale (LSAS) scores in patients continuing fluvoxamine treatment as compared to those given placebo. Clinical Global Impressions of Severity of illness (CGI-S) and Sheehan Disability Scale (SDS) scores also tended to be lower in the fluvoxamine group than in the placebo group.

The overall incidence of treatment-emergent signs and symptoms (TESS) was higher in the fluvoxamine CR group (68%) than in the placebo group (53%). Symptoms were primarily mild to moderate in severity. Furthermore, asthenia, headache, nausea, dry mouth, insomnia, sweating, and abnormal ejaculation were reported in more patients taking fluvoxamine. Signs of sexual dysfunction were also reported more frequently in fluvoxamine-treated patients.

Dr. Stein concludes that "these data support the long-term efficacy, safety, and tolerability of fluvoxamine CR in the treatment of GSAD." Furthermore, he recommends "that pharmacotherapy of this disorder should be continued beyond the acute phase."

Int J Neuropsychopharmacol 2003;6:317-323. "Fluvoxamine CR in the long-term treatment of social anxiety disorder: the 12- to 24-week extension phase of a multicentre, randomized, placebo-controlled trial"

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