First-line antidepressants: selective serotonine reuptake inhibitors

Antidepressants are widely used in psychiatry and general clinical practice and are among the most commonly prescribed medications. First-line antidepressants are selective serotonin reuptake inhibitors (SSRIs), which in recent decades have replaced tricyclic antidepressants (TCAS), which are comparable to SSRIs in efficacy but significantly inferior in tolerability and safety. The main indications for prescribing antidepressants are depression and anxiety disorders. In addition, certain antidepressants are used in the treatment of obsessive-compulsive disorder, post-traumatic stress disorder, insomnia and other disorders. Fluvoxamine occupies a special place among SSRIs, the distinctive features of which are good tolerability, selective effect on the symptoms of obsessive-compulsive disorder, including in children and adolescents, which, combined with high safety, allows it to be prescribed to children from the age of eight, as well as the highest affinity for σ1-receptors among SSRIs, which creates special properties of fluvoxamine, benefits in improving cognitive functions, treating psychotic depression and mental disorders complicated by aggressive behavior. Due to its good tolerability, fluvoxamine is considered the safest antidepressant for elderly patients and patients with cardiovascular diseases. Fluvoxamine’s remarkable ability to reduce neuroinflammation creates special advantages for it in the treatment of major depressive disorder and suggests certain prospects for the prevention and treatment of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease and Huntington’s disease.

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