Clin Psychiatry. 1993 Jul;54(7):280.
Clin Psychiatry. 1994 Feb;55(2):77-9.
Akathisia, suicidality, and
Hamilton MS, Opler LA.
Psychiatry, College of Physicians and Surgeons of Columbia University, New
BACKGROUND: The propose link between fluoxetine and suicidal
ideation is explained by fluoxetine-induced akathisia and other dysphoric
extrapyramidal reactions. METHOD: The following literature is reviewed: (1) the
subjective response of schizophrenics to akathisia, including evidence that
akathisia gives rise to suicidal ideation; (2) the subjective reports of
patients taking fluoxetine; and (3) preclinical studies describing the role of
serotonin in the extrapyramidal system and suggesting a mechanism whereby
fluoxetine can induce extrapyramidal side effects. RESULTS: The literature
suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of
de novo suicidal ideation. CONCLUSION: We propose a syndrome which we name
Extrapyramidal-Induced Dysphoric Reactions, one extreme manifestation of which
is the emergence of suicidal ideation. We further propose 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.