Use of Original and Generic Fluvoxamine in Clinical Psychiatric and Neurological Practice for the Treatment of Depression (Physician Survey Results)

Abstract

Rationale. Selective serotonin reuptake inhibitors (SSRIs) are the first-line medicinal medications for outpatient treatment of mild to moderate depressive episodes. The existing differences in the efficacy and safety profiles of original and generic medicinal products largely define the therapeutic tactics, complicating the choice of a particular antidepressant by the specialist. Current data comparing original and generic antidepressants are limited, so additional studies are needed.

Objective. To assess the physicians’ therapeutic approach and decision flow regarding the use of antidepressants, including patterns of prescribing original or generic fluvoxamine in their routine practice.

Materials and Methods. 537 physicians from various regions of the Russian Federation participated in the anonymous survey, including 315 (58.66 %) neurologists and 222 (41.34 %) psychiatrists. The SurveyMonkey® tool was used for data collection. The analysis of the obtained results was primarily carried out using descriptive statistical methods.

Results. Over a quarter of psychiatrists (27.5 %) and about a fifth of neurologists (19.4 %) reported negative experiences with generic medications. The key concerns for prescribing generic fluvoxamine were reduced efficacy (psychiatrists 73.0 %, neurologists 77.5 %) and poor tolerability (psychiatrists 62.6 %, neurologists 67.3%). When choosing generic fluvoxamine, physicians regardless of specialty were significantly more likely to prescribe a dose exceeding 100 mg to achieve the required therapeutic effect (p < 0.0001). Twice as many physicians (17.1 %) reported the onset of the original fluvoxamine effect as early as the first week of use compared to those using the generic (7.6 %). More than half of respondents (55 %) assessed the frequency of known adverse events after taking the original fluvoxamine as very rare, with a multiple increase in the frequency of adverse events observed with the generic form (2.4 times for “very common”, 2.2 times for “common”).

Conclusion. According to the majority of psychiatrists and neurologists surveyed, a more rapid onset of therapeutic effect and a lower frequency of adverse events are observed when using the original fluvoxamine.