Abstract

RISK OF DEPRESSION WITH FLUNARIZINE USE IN MIGRAINE PROPHYLAXIS: CLINICAL EVIDENCE AND MANAGEMENT

G. Indira*, V. Abhinaya Rajeswari, N. Lokeswari, Y. Shyni, Dr. B. Dhanush,
Dr. K. Padmalatha

ABSTRACT

As a calcium channel blocker, flunarizine has a long history of successful usage in migraine prophylaxis, reducing migraine attack frequency, intensity, and duration.[1,2] Its pharmacological effects stem from its capacity to modulate neuronal excitability and decrease cortical spreading depression, two critical pathways in migraine pathophysiology.[22] There is growing evidence that flunarizine has major neuropsychiatric side effects, such as depression, which has prompted worries regarding its long-term usage, despite its proven effectiveness in migraine prevention.[3] A number of research, including randomized controlled trials, observational studies, and post-marketing monitoring studies, have shown that flunarizine does not often cause depressed symptoms in patients.[4,5] Depression is more likely to occur in older patients, those who have a history of mood disorders, and those who take higher doses of flunarizine.[6,7] Some theories propose that flunarizine-induced depression occurs as a resultof drug buildup in the CNS, disruption of serotonergic and noradrenergic neurotransmission, and central dopaminergic blockage.[8,9] Since depression symptoms are frequently reversible with a decrease in dosage or withdrawal of flunarizine.[10-12] patient selection, initial psychiatric examination, and follow-up are highly important.

Keywords: Flunarizine, Migraine prophylaxis, Drug-induced depression, Calcium channel blockers, Adverse drug reactions.