Reboxetine versus fluvoxamine in the treatment of motor vehicle accident-related posttraumatic stress disorder: A double-blind, fixed-dosage, controlled trial

Background: Motor vehicle accidents (MVAs) are a leading cause of posttraumatic stress disorder (PTSD) in the general population. Alterations in norepinephrine and serotonin systems have been proposed as mechanisms involved in the pathophysiology of the condition, with treatment directed at these neurotransmitter systems. Reboxetine, a selective norepinephrine reuptake inhibitor, exhibits high affinity and selectivity for the human norepinephrine transporter. Inasmuch as PTSD may be associated with dysregulation of noradrenergic activity, the present double-blind randomized clinical trial intended to evaluate reboxetine's efficacy in the management of MVA-related PTSD and to compare its efficacy with a medication commonly used in PTSD, the selective serotonin reuptake inhibitor fluvoxamine. Methods: Forty patients with MVA-related PTSD attending a local community mental health outpatient clinic were randomized to receive a fixed dose of either reboxetine (8 mg/d) or fluvoxamine (150 mg/d) in a double-blind fashion for a period of 8 weeks. Results: At baseline and at study end point, the 2 subgroups demonstrated no statistical differences in scores on PTSD, depression, and anxiety rating scales. Both medications led to significant improvements in all clinical scales measured. Nine patients receiving reboxetine and 3 receiving fluvoxamine withdrew from the study because of side effects. Conclusions: Study observations indicate comparable efficacy of reboxetine and fluvoxamine in the management of MVA-related PTSD despite reboxetine's selective noradrenergic activity. Reboxetine appears to be at least as effective as fluvoxamine and may offer an alternative management option in this often difficult-to-treat and disabling condition. A lower and flexible reboxetine dosing schedule will be recommended for future research to improve its tolerability in PTSD patients.