Fluoxetine increases suicide ideation less than placebo during treatment of adults with minor depressive disorder.
The Treatment for Adolescents With Depression Study (TADS): Outcomes Over 1 Year of Naturalistic Follow-Up
The Treatment for Adolescents With Depression Study (TADS) evaluated the effectiveness of fluoxetine, cognitive-behavioural therapy, & their combination in adolescents with major depressive disorder. The authors report effectiveness outcomes across a 1-year naturalistic follow-up period. 66% of eligible subjects participated in at least one stage of the follow-up. The benefits seen at the end of […]
This article includes a discussion between J Mann and J R Cornelius.
Modeling of the Temporal Patterns of Fluoxetine Prescriptions and Suicide Rates in the United States
The associations between suicide rates & dispensing of fluoxetine in the United States during 1960-2002 were examined. Suicide rates fluctuated between 12.2 & 13.7 per 100,000 for the entire population from the early 1960s until 1988. Since then, suicide rates have gradually declined; this decline is significantly associated with increased numbers of fluoxetine prescriptions dispensed. […]
Fluoxetine Dose-Increment Related Akathisia in Depression: Implications for Clinical Care, Recognition and Management of Selective Serotonin Reuptake…
The authors report the case of a 22-year-old woman presenting major depressive episode with severe akathisia after an increase in fluoxetine. The patient developed severe restlessness & suicidal ideation approximately 1 week after the dosage of fluoxetine was doubled, 1 year on from when the drug was first introduced. The clinical implications are discussed. A […]
This paper examines the empirical evidence for a possible association between fluoxetine use & either violent or suicidal behaviour, based on a literature review of 62 references from 1988 to 1995. The author finds that the evidence supports only an equivalent or decreased risk for emergent suicidal ideation or aggression during fluoxetine therapy as compared […]
For commentary on this paper, please see SIEC #2005-0137
All published papers on Medline & other databases linking serotonin, SSRIs & aggression were reviewed. Results showed that a small proportion of patients treated with SSRIs may become akathisic & others may show increases in anxiety in the initial phases of treatment, but no increased susceptibility to aggression or suicidality could be connected with fluoxetine […]
Fluoxetine, Cognitive-Behavioral Therapy, and Their Combination for Adolescents With Depression: Treatment for Adolescents With Depression Study (TADS)…
The objective of this study was to evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder: 12 weeks of 1) fluoxetine alone, 2) cognitive-behavioral therapy (CBT) alone, 3) CBT with fluoxetine, or 4) placebo. Among the findings, clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved […]
For a reply to this article, please see SIEC #2003-0583.
Reply to D Wilkinson – Loss of Anxiety and Increased Aggression in a 15-year-old boy Taking Fluoxetine
For the original article by D Wilkinson, please see SIEC #2003-0582.
Fluoextine-Induced Suicidal Ideation: an Examination of the Medical Literature, Case law, and the Legal Liability of Drug Manufacturers
This article summarizes the research studies that have found no link between fluoxetine & suicidal ideation, & examines the court cases & legal implications surrounding this issue.
At the same time as clinicians are being exhorted to prevent suicide by employing questionable treatment approaches, there has been simultaneous concern that use of psychotropic drugs might somehow provoke suicidal behaviour in a subgroup of vulnerable patients. This concern extends to areas outside psychiatry, relating for example to treatment with cardiovascular drugs & the […]
The Utilization of Antidepressants – a key Issue in the Prevention of Suicide: an Analysis of 5281 Suicides in Sweden During the Period 1992-1994
Results of a 3-yr.toxicological screening of suicide deaths & use of antidepressants conclude: 1. Depressed patients are under-treated with antidepressants & physicians’ awareness & diagnosis of depression need to be improved 2. Clinical trials of new antidepressants should be designed to reveal differences in thereapeutic efficacy compared to reference tricyclics. A huge increase in the […]
The Prozac controversy is an American phenomenon not seen in Europe. Kelleher states that special factors that may explain this lie in the litigious nature of American society & the marketing techniques used to launch Prozac. Neither clinical or numerical science validates a causal relationship between the use of fluoxetine & the development of suicidal […]
Platelet 5-HT Uptake Sites, Labelled With 3H Paroxetine, in Controls and Depressed Patients Before and After Treatment With Fluoxetine or Lofepramine
Platelet 3H paroxetine was measured in 73 depressed patients & 64 healthy volunteers. No differences were found in Bmax or Kd. None of the subgroups differed significantly from controls. 40 of the depressed subjects were retested after 6 weeks’ treatment with fluoxetine or lofepramine. Treatment was not associated with any change in Bmax but an […]
The authors present a case of seizure following fluoxetine overdose in a previously well 15-year-old female with a clear history of sole ingestion. The presence of other substances was ruled out with comprehensive drug screening. Increased serum levels of fluoxetine & its active metabolite were documented. Follow-up revealed that the patient sustained no further seizures […]
Several reports have appeared examining the claim that fluoxetine is associated with a disproportionately high risk of suicidality. In this letter to the editor, the authors report on a pilot study of 17 psychiatric inpatients taking fluoxetine & 11 psychiatric controls taking other antidepressants. No evidence was found to support the claim that fluoxetine is […]
This Letter to the Editor comments on A.J. Rothschild & C.A. Locke’s case treatment of a depressed woman who also needed pain medication (see SIEC AN 920236), & notes that for patients taking monoamine oxidase inhibitors (MAOIs), narcotic treatment should be initiated from 20% to 50% of the usual dosage & dosages be titrated cautiously […]
Comparison of Frequencies of Suicidal Tendencies Among Patients Receiving Fluoxetine, Lofepramine, Mianserin, or Trazodone
To evaluate whether fluoxetine causes an important increased risk of suicidal behaviour, the frequency of attempted suicide, suicidal ideation, & aggressive behaviour was compared in persons who received fluoxetine, lofepramine, mianserin & trazodone. The frequency of these events in the 90 days after the study drug was started was similar for all user groups. Data […]
Analyses of Suicidality in Double-Blind, Placebo-Controlled Trials of Pharmacotherapy for Weight Reduction
Suicidality data from 11 double-blind, controlled trials in the United States Investigational New Drug fluoxetine obesity clinical trial data base (3819 randomized outpatients) were analyzed. Conclusion: Suicidality occurs but has a low incidence rate in the obese who seek pharmacologic weight-reduction therapy. Fluoxetine-treated & placebo treated patients did not differ statistically in the incidence of […]
The author believes a lack of understanding of drug therapy fuels extreme perceptions about Prozac & that knowing its mechanics can demystify its powers while generating respect for its complexity & efficacy. Prozac is considered a breakthrough drug for treating depression, bulimia & obsessive-compulsive disorder. The article discusses Prozac pharmacodynamics, pharmacokinetics & psychopharmacology in common […]