April 2, 2025
Los pacientes con trastornos depresivos exhiben una secreción disminuida de melatonina y los nive les nocturnos de esta tienen una correlación inversa con la severidad de la depresión.1,7
La terapia con fluvoxamina está asociada a un incremento significativo de las concentraciones plasmáticas de melatonina, durante la noche y en las primeras horas del día.1,2,8,11
Ello se debe, principalmente, a que el metabolismo hepático de fluvoxamina induce la inhibición de las enzimas CYP1A2 y CYP2C19, responsables de la degradación de la melatonina.2,9,12
Referencias
1. Silva S, Bicker J, Falcao A, Fortuna A. Antidepressants and circadian rhythm: exploring their bidirectional interaction for the treatment of depression. Pharmaceutics 2021; 13: 1975-2008.
2. Sunami E, Usuda K, Nishiyama Y, et al. A preliminary study of fluvoxamine maleate on depressive state and serum melatonin levels in patients after cerebral infarction. Intern Med 2012; 51: 1187-93.
3. Charrier A, Olliac B, Roubertoux P, Tordjman S. Clock genes and altered sleep-wake rhythms: their role in the development of psychiatric disorders. Int J Mol Sci 2017; 18: 938-59. 4. Boiko DI, Shkodina AD, Hasan MM, et al. Melatonergic receptors (Mt1/Mt2) as a potential additional target on novel drugs for depression. Neurochem Res 2022; 47: 2909-24.
5. Lesicka M, Dmitrazk-Weglarz M, Jablonska E, et al. Methylation of melatonin receptors in patients with unipolar and bipolar depression. mech Ageing Dev 2023; 211: 111776.
6. Wang YQ, Jiang YJ, Zou MS, et al. Antidepressant actions of melatonin and melatonin receptor agonist: focus on pathophysiology and treatment. Behav Brain Res 2022; 420: 113724.
7. Li C, Ma D, Li M, et al. The therapeutic effect of exogenous melatonin on depressive symptoms: a systematic review and meta-analysis. Front Psychiatry 2022; 13: 737972.
8. Wilde MI, Plosker GL, Benfield P. Fluvoxamine: an update review of its pharmacology, and therapeutic use in depressive illness. Drugs 1993; 46: 895-924.
9. Von Bahar C, Ursing C, Yasui N, et al. Fluvoxamine but not citalopram increases serum melatonin in healthy subjects – an indication that cytochrome P450 CYP1A2 and CYP2C19 hydroxylate melatonin. Eur J Clin Pharmacol 2000; 56: 123-7.
10. Härtter S, Wang X, Weigmann H, et al. Differential effects of fluvoxamine and other antidepressants on the biotransformation of melatonin. J Clin Psychopharmacol 2001; 21: 167-74.
11. Hao Y, Hu Y, Wang H, et al. The effect of fluvoxamine on sleep architecture of depressed patients with insomnia: an 8-week, open-label, baseline-controlled study. Nat Sci Sleep 2019;11: 291-300.
12. Westenberg HGM, Sandner C. Tolerability and safety of fluvoxamine and other antidepressants. Int J Clin Pract 2006; 60: 482-91
