HOW DOES FLUVOXAMINE COMPARE TO PROZAC (FLUOXETINE) AND DOES IT AFFECT THE HPA AXIS? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
HOW DOES FLUVOXAMINE COMPARE TO PROZAC (FLUOXETINE) AND DOES IT AFFECT THE HPA AXIS? 
Question: How does Luvox (fluvoxamine) compare to Prozac (fluoxetine) and does it affect the HPA axis? Dear Doctor Heller, Thank you for your website which has given me some hope. I have been caring for a young woman since she was 5 years (now 17). She has definite signs of borderline, as have two other members of her natural family. A few years ago we visited a pediatric psychiatrist who reported to our GP that BPD was most likely. He gave a grim assessment of any possible help. She is on 25 mg Fluvoxamine daily but that’s all. I have been using homeopathic treatments to try to help. I have recently come across a study that fluvoxamine 150mg daily for six weeks reduces the responsiveness in the HPA axis of BPD patients. What is your opinion of this? Do you think the fluvoxamine 25 mg that she is on is a helpful option, or should I discuss the treatment program that you have outlined on the website with the GP? She tries so hard, and I feel so sad when I can see that things are building up for failure. Whenever she tries to lead a ‘normal’ type of life (part time work, etc.), the pattern is the same: extreme anxiety (she seems hyperalert to how others are going to accept her), then manic type behavior, then she becomes angry whenever she interprets something (even a look on someone else’s face) as rejection or disapproval. She can’t hold the anger in, but it all ‘blows up’, and she is left feeling low again. She is constantly seeking approval through attention seeking behavior (‘If I am not getting attention I feel as though I am nothing’), but she keeps trying to fit in etc., and I desperately want to help her. I would be grateful for your opinion on the trial, and whether the Prozac treatment you outline would be a good option for her to try. Thanks for the website Dr. Heller’s Answer: The hypothalamic pituitary axis (HPA) is impaired in many individuals with the BPD, with or without medications. Im not aware of any SSRI effects (drugs like Luvox (fluvoxamine) or Prozac (fluoxetine)) although Tegretol (carbamazepine) can affect the system–particularly thyroid. I dont prescribe Fluvoxamine, and I havent seen any effects with thyroid, sex hormone, or cortisol function with Prozac (fluoxetine). Individuals with the BPD who are unstable cannot be controlled alone with an SSRI. A mood stabilizer and/or antipsychotic is necessary. Prozac (fluoxetine) is by far the most effective SSRI–likely because of its effects on glial cell function. Tegretol (carbamazepine) is much more effective than any other mood stabilizer. Chronic antipsychotic use is a problem. Zyprexa (olanzapine) is the best but tends to cause significant weight gain. I generally use Abilify (aripiprazole) if I need to prescribe an antipsychotic chronically. Haldol (haloperidol) is great for as needed use. Risperdal one 3mg dose for severe dysphoria works in 24 hours. As always, making all the medically treatable diagnoses and comprehensively treating them is crucial. The BPD itself doesnt have a grim prognosis. It all depends on the comorbidities (the other diagnoses). Character disorders, the passive aggressive personality and antisocial personality disorders combined with the BPD are huge problems, and substance abuse that doesnt respond to treating the mental health problems also has a grim prognosis. 
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