title: The opposite effects of fluvoxamine and sertraline in the treatment of psychotic major depression: a case report.
abstract: BACKGROUND
  Psychotic major depression is a clinical subtype of major depressive disorder. A number of clinical studies have demonstrated the efficacy of the combination of an antidepressant (for example, a tricyclic antidepressant or selective serotonin reuptake inhibitor (SSRI)) and an atypical antipsychotic or electroconvulsive therapy (ECT) in treating psychotic major depression. In several studies, monotherapy of SSRIs such as fluvoxamine has been shown to be effective in the treatment of psychotic major depression.
  
  
  METHODS
  We report on a 36-year-old Japanese woman in whom fluvoxamine (a SSRI with sigma-1 receptor agonist) and sertraline (a SSRI with sigma-1 receptor antagonist) showed the opposite effects on psychotic symptoms in the treatment of psychotic major depression.
  
  
  RESULTS
  Symptoms of depression and psychosis in the patient who was non-respondent to antipsychotic drugs improved after fluvoxamine monotherapy. At 3 years later, a switch to sertraline from fluvoxamine dramatically worsened the psychotic symptoms in the patient. Then, a switch back to fluvoxamine from sertraline improved these symptoms 1 week after fluvoxamine treatment.
  
  
  CONCLUSIONS
  Doctors should consider the monotherapy of sigma-1 receptor agonist fluvoxamine as an alternative approach to treating psychotic major depression.
authors.affiliation: Yonago Medical Corporation, Yonago Clinic, Yonago, Tottori, Japan. yk3march@gc4.so-net.ne.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Kishimoto
authors.forename: Ayako
authors.initials: A
authors.lastname: Todani
authors.forename: Junko
authors.initials: J
authors.lastname: Miura
authors.forename: Tetsuno
authors.initials: T
authors.lastname: Kitagaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Hashimoto