Does Fluvoxamine help with bipolar disorder? (BD)

In this article, we will answer the question “Does Fluvoxamine help with bipolar disorder?”. We will also discuss what research has to say on this matter and what other alternative treatments and strategies are available to help manage bipolar disorder (BD).

Does Fluvoxamine help with bipolar disorder?

No, Fluvoxamine (also known as Luvox) cannot help with bipolar disorder. It can help with the diagnosis of bipolar disorder. Antidepressants carry a risk of triggering manic episodes in patients taking therapy. If an individual has bipolar disorder, it may be unmasked by this mechanism. Due to this reason, all antidepressants, including Fluvoxamine, should be used with caution and under continuous monitoring by a healthcare professional.

Bipolar disorder (BD) is a manic-depressive illness that can cause changes in an individual’s mood and energy. In individuals with BD, this disease interferes with their normal ability to function. It can cause extreme mood swings like mania or hypomania (considered an emotional high) and depression (considered an emotional low). BD can be divided into various categories like bipolar disorder type I, bipolar disorder type II, cyclothymic disorder and bipolar disorders not otherwise specified (1,2).

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is commonly used for obsessive-compulsive disorder (OCD). However, as it is an antidepressant, clinicians may prescribe it as an adjunct to mood stabilizers (like lithium, carbamazepine or lamotrigine) or antipsychotics (like olanzapine or risperidone) for depression related to BD only if other treatment strategies do not work. Fluvoxamine has the potential to cause or trigger mania in individuals taking the medication, so it should always be used with utmost caution in BD patients (3).

What does research suggest?

Research studies conducted on the use of SSRIs for the management of BD symptoms suggest that these medications can only be used under specific conditions, for a short time and under constant monitoring by a healthcare provider.

A research study states that the risk of treatment-emergent mania is high in patients treated with antidepressants. Even when used as adjunctive therapy with mood stabilisers, they are known to cause mania in almost 2-6% of patients (4).

One clinical study has found SSRIs beneficial for BD type II patients as they improved the depressive symptoms of the disorder over long-term usage of 9 months without triggering any manic episodes in individuals receiving treatment. However, this study was conducted on a small sample size and needs more research to prove the same (5).

A study comparing the effects of Fluvoxamine and clomipramine in BD patients suffering from depression reported that Fluvoxamine, instead of clomipramine was a better option in such patients. Clomipramine exerted more severe side effects when compared to Fluvoxamine (6).

A few case studies on the occurrence of manic episodes in BD patients on Fluvoxamine therapy were also reported. Fluvoxamine as an adjunct to lithium was effective in treating depression in all cases, but immense caution is required in patients during the treatment of bipolar depression with these medications (7).

Another research conducted on the safety and efficacy of antidepressants in the treatment of depression in BD patients reported that SSRIs can be added to the therapeutic regimen only if a mood stabilizer is not working as monotherapy. Even then the use of SSRIs should be limited to a short duration and close monitoring should be done to avoid manic episodes in individuals taking therapy (8). 

What other medications are available for bipolar disorder?

Management of the symptoms of BD is a continuous process for which many medications are available. As each individual is different, the choice of medication can also vary from person to person. Your doctor may prescribe one or more of the following medications to manage your symptoms:

Mood-stabilising medications

Manic episodes of BD can be controlled with mood-stabilising medications like lithium, carbamazepine or lamotrigine. Your doctor will prescribe you one of these and add another medication if needed.

Antipsychotics and antidepressants

If mania is not controlled then your doctor may add an antipsychotic medication along with a mood stabiliser like olanzapine or risperidone to help manage the manic episodes. Antipsychotics can also help alleviate depression related to BD. 

If depressive symptoms are not managed through the addition of antipsychotics, another option is adding antidepressants like SSRIs to decrease the depression in such patients. Antidepressants have the potential to cause mania so they should be used with caution. Your doctor may also use triple therapy of mood stabilisers, antipsychotics and antidepressants to manage your symptoms.

Benzodiazepines

Benzodiazepines are another class of drugs that can help BD patients in managing their symptoms. Short-term treatment with benzodiazepines can help manage anxiety and insomnia in patients with BD.

Many different treatment options are available to manage BD and related symptoms. You will need to be patient and persistent with your medications to see which one works best for you. If you feel your symptoms are worsening you do not stop taking your medications, instead, consult your doctor and let him assess if any change in therapy is required.

What non-pharmacological interventions are available for bipolar disorder?

In addition to pharmacological treatment, different non-pharmacological strategies are also available which can help with the management of BD. Some of these are as follows (9,10,11):

Cognitive behavioural therapy (CBT)

CBT helps patients think positively about their illness and that they can overcome the symptoms. It teaches patients proper stress management strategies. CBT changes unhealthy ways of thinking and behaving which can bring positive changes in your mood.

Family-focused therapy (FFT)

FFT is a psychoeducational therapy for BD patients and their caregivers. This is normally given to patients as an add-on to pharmacological therapy after an illness episode. It includes communication enhancement and problem-solving training given to both patient and their families. Family support can help BD patients manage their symptoms better.

Interpersonal or social rhythm therapy (IPSRT)

IPSRT specifically targets patients with BD. It focuses on daily rhythms and helps BD patients in managing a stable daily routine. If the rhythms of sleeping, waking, exercise and diet are in a consistent routine it can help improve mood in BD patients.

Psychoeducation

Psychoeducation combines CBT, group therapy and education to help BD patients manage their symptoms. This has been found to help in managing difficult-to-treat patients of BD. This is focused on providing patients with a theoretical and practical approach to managing their symptoms. Psychoeducation educates patients on their illness, coping mechanisms and various consequences. This can be used as an add-on to pharmacological therapy, as it can increase its efficacy. It can improve long-term outcomes in BD patients.

Non-pharmacological somatic treatments

Patients with BD have always benefited from non-pharmacological somatic treatment options. Some of the treatment strategies found helpful for BD patients are as follows:

Electroconvulsive therapy (ECT)

ECT is the process in which brief currents are sent through your brain. It induces seizures through the brain which can change brain chemistry reversing symptoms of bipolar mania or depression. ECT proves to be an effective treatment for both conditions. ECT can however cause cognitive adverse effects and relapse. It is only used for patients who do not respond to other options of treatment.

Repetitive transcranial magnetic stimulation (rTMS)

rTMS is a brain stimulation technique in which magnetic pulses are applied to a specific brain region to regulate cortical excitability. This technique has shown beneficial effects on treatment-resistant depression. rTMS has been approved by the FDA for the treatment of major depressive disorder (MDD). It has yet to be approved for the treatment of bipolar disorder, but it has shown good therapeutic potential.

Vagus nerve stimulation (VNS)

VNS uses an implanted device to send electrical signals to your vagus nerve in the brain. It can then alter the specific neurotransmitters involved in mood regulation. VNS is approved by the FDA for treatment-resistant bipolar depression.

Conclusion

In this article, we discussed the role of Fluvoxamine in BD management and what evidence research studies have provided regarding its effectiveness. We also discussed different pharmacological and non-pharmacological treatment strategies for BD.

In my opinion, Fluvoxamine cannot help with BD, but only with BD-related depression. However, due to the potential of manic episodes, it should be continuously monitored. Also, many other treatment strategies are available which can be used as an adjunct to pharmacological therapy to help patients effectively manage their symptoms.

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