706. EFFECT OF FLUOXETINE TO PROGRESSIVITY OF INTERVERTEBRAL DISC DISORDER OF PATIENTS WITH PSYCHIATRIC COMORBIDITY IN MARIA WALANDA MARAMIS DISTRICT GENERAL HOSPITAL OF NORTH MINAHASA, INDONESIA

Abstract Background Prolonged stress can significantly impact neuromuscular health through various mechanisms, including inflammatory response, oxidative stress, and abnormal mechanical stress. Comorbidity of psychiatric disorder and intervertebral disc degeneration are common, where patients with herniated intervertebral disc were at high risk of developing major depressive disorder (Kao et al, 2021). Caiafo e.al (2016) had demonstrate that fluoxetine exerts a significant effect of anti-inflammatory, antiapoptotic, and antioxidant, suggestive to the clinical benefit in inhibiting progressivity of intervertebral disc disorders. Aims & Objectives This study was done to evaluate progressivity of intervertebral disc disorders in patients with psychiatric comorbidity treated with fluoxetine, by evaluating changes in MRI readings and functional disability, thus to explore the potential use of SSRI as protective agent towards deterioration of intervertebral disc disorder condition. Method We conduct cohort study to follow the cases of patients coming to Psychiatry Outpatient Clinic for treatment of psychiatric disorder (depression, anxiety, OCD) with intervertebral disc disorders (protrusion, herniation, stenosis, compression) confirmed by MRI and undergoing routine physiotherapy as advised by medical rehabilitation specialist. Data collection was done between October 2023 to May 2025, and eleven patients completed the study by taking second MRI one year after the first one, during which the fluoxetine was taken daily on 20mg. MRI readings were compared by radiologist’s expertise using Pfirmann grading, and pain and disability assessment were done monthly at the time for psychiatry consultation using Oswestry Disability Index (ODI). Results Eleven patients evaluated in this study were four female, three with cervical disc disorders and one with cervical and lumbar disc disorder, and seven male, five with thoracolumbar and lumbar disc disorder, while the other two had cervical and thoracic disc disorder. Age of the patients ranged from 48 to 67 years old, nine works in office setting and two are farmers. Psychiatric diagnosis were eight with Major Depressive Disorder, two with Generalized Anxiety Disorder, and one with Obsessive-Compulsive Disorder. From first MRI reading eight were having Pfirmann II-III, and three had Pfirmann III. ODI scores interpretation were seven having minimal disability, and four fell to moderate disability. During the one year treatment all patients improved significant improvement in ODI scoring, with final score interpretation at the 12th month showing no and minimal disability. Second MRI reading showed no significant change compared to the first. Discussion & Conclusions Intervertebral disc degeneration is a complex process influenced by multiple factors, often associated with aging but can be accelerated due to other causes such as genetics, lifestyle, and mechanical stress (Fernandez-Moure et al., 2018). Although second MRI is proven unnecessary due to no significant change apparent within two year (Tome-Bermejo et al, 2024), most patients with intervertebral disc disorder will usually still got a second MRI after one year due to the chronic disabling pain it caused. While fluoxetine is not currently recognized as a protective factor against intervertebral disc degeneration, the functional disability has proven to have impacted, suggesting that a broad range of therapeutic targets, such as oxidative stress reduction and apoptosis inhibition, might beneficial in managing this condition.