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 […]

Fluoxetine and Suicide Rates: Suicide and the Economy


Treating the Substance-Abusing Suicidal Patient

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 […]

Suicidal and Violent Behavior Associated With the use of Fluoxetine

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 […]

Treatment of Major Depressive Disorder in Children and Adolescents

For commentary on this paper, please see SIEC #2005-0137

Selective Serotonin Reuptake Inhibitors and Violence: a Review of the Available Evidence

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 […]

Loss of Anxiety and Increased Aggression in a 15-year-old boy Taking Fluoxetine

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.

Pharmacological Provocation and Prevention of Suicidal Behaviour

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 […]

Fluoxetine & Suicide: the Prozac Controversy

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 […]

Seizure After Isolated Fluoxetine Overdose

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 […]

Putative Fluexetine-Related Suicidality

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 […]

Absence of a Relationship Between Adverse Events and Suicidality During Pharmacotherapy for Depression

17 double-blind controlled clinical trials were evaluated for treatment-emergent side effects (e.g. akathisia) & suicidality with fluoxetine, placebo & tricyclic antidepressants. 9 relevant adverse event clusters were evaluated. Most patients reported neither a cluster event nor suicidality. Where suicidality was reported, it was not in temporal association with an adverse event cluster. No increased risk […]

Suicide, Violent Behaviour and Fluoxetine

This article traces fluoxetine use in Asutralia & notes that media concerns about it’s safety has alarmed patients receiving the drug. Research studies are cited. Meta-analysis of clinical trials shows that fluoxetine does not cause or increase suicidal behavior or violent acts. The authors describe it as neither a panacea nor a personality pill but […]

MAOI-Narcotic Interactions

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 […]