Comment in:
·
J Clin Psychiatry. 1992
Jul;53(7):256-7.
·
J Clin Psychiatry. 1993 Nov;54(11):439.
Reexposure to fluoxetine
after serious suicide attempts by three patients: the role of
akathisia.
Rothschild AJ, Locke
CA.
McLean Hospital, Department of Psychiatry, Harvard Medical
School, Belmont, MA 02178.
Considerable controversy exists regarding the
relationship between fluoxetine and the emergence of suicidal ideation. Three
cases are presented of patients who were reexposed to fluoxetine after having
previously made a serious suicide attempt during fluoxetine treatment. All three
patients developed severe akathisia during retreatment with fluoxetine and
stated that the development of the akathisia made them feel suicidal and that it
had precipitated their prior suicide attempts. The akathisia and suicidal
thinking abated upon the discontinuation of the fluoxetine or the addition of
propranolol. The emergence of suicidal ideation during treatment with fluoxetine
may be secondary to the development of akathisia. Gradual increments of
fluoxetine dose and the prompt recognition and treatment of akathisia may reduce
further the rare occurrence of suicidal ideation during fluoxetine
treatment.
