This article, based on a literature review, suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of de novo suicidal ideation. It proposes a syndrome called Extrapyramidal-Induced Dysphoric Reactions, one extreme manifestation of which is suicidal ideation, & a heuristic “Four Neuron Model of the Extrapyramidal Motor System” in which increased serotonin activity, by inhibiting the nigrostriatal dopamine tract, is capable of inducing extrapyramidal side effects. (36 Refs.)