The Fluoxetine and Suicide Controversy : A Review of the Evidence

Abstract

Evidence is emerging that a range of psychotropic drugs may precipitate akathisia and/or panic reactions in predisposed patients. The use of fluoxetine has hitherto been the most notable example of this occurrence. These reactions may foster the genesis of suicidal ideation in a small proportion of patients. At present, it is not clear what biological mechanism may underlie this finding. The serotonin (5-hydroxytryptarnine; 5-HT) system may be involved in these reactions.The best management of such reactions will involve counselling patients beforehand about the possibility of these reactions, stopping treatment with the agents if such a reaction is suspected, or adding an agent with 5-HT1A antagonistic properties (e.g. propranolol) to the treatment regimen.