Fluoxetine vs. propranolol in the treatment of vasovagal syncope: a prospective, randomized, placebo-controlled study.
OBJECTIVE
To compare the therapeutic efficacy of placebo, propranolol, and fluoxetine in patients with vasovagal syncope (VVS).


RESULTS
Ninety-six consecutive patients with VVS were randomized to treatment with placebo, propranolol, or fluoxetine and followed-up for 6 months. Before and during treatment, they reported their syncopal and presyncopal episodes and graded their well-being, expressed as the general evaluation of life, general activities, and everyday activities (each scaled from 1 = very good to 5 = very bad). Two patients refused follow-up. Among the remaining 94, no difference between groups was observed regarding the distribution of time of vasovagal events (syncopes or presyncopes) during follow-up (log-rank test). No difference was also observed when syncopes and presyncopes were assessed separately. Eighteen patients discontinued therapy. Among the remaining 76 ('on-treatment' analysis), the mean time to a vasovagal episode (syncope or presyncope) was significantly longer in the fluoxetine group when compared with the two other groups (log-rank test, P < 0.05). A significant difference in favour of fluoxetine was also observed regarding presyncopes. The difference between groups regarding the syncope-free period was not significant. During therapy, patients' well-being was improved (decreased) only in the fluoxetine-group (13.4 +/- 0.7 vs. 15.4 +/- 0.9 before treatment, P < 0.01).


CONCLUSIONS
Fluoxetine seems to be equivalent to propranolol and placebo in the treatment of VVS. However, it improves patients' well-being and might be more effective in reducing presyncopes and total vasovagal events in some patients with recurrent VVS.
Theodorakis
George N
GN
Second Department of Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 17674 Athens Greece. elbee@ath.forthnet.gr
Leftheriotis
Dionyssios
D
Livanis
Efthimios G
EG
Flevari
Panagiota
P
Karabela
Georgia
G
Aggelopoulou
Nikolitsa
N
Kremastinos
Dimitrios Th
DT
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D001294:Attitude to Health; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D011788:Quality of Life; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D019462:Syncope, Vasovagal / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D005473:Fluoxetine; D011433:Propranolol; D017367:Selective Serotonin Reuptake Inhibitors