Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T02:25:31.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Fluoxetine and Suicidal Behaviour

Some Clinical and Theoretical Aspects of a Controversy

Published online by Cambridge University Press:  02 January 2018

A. C. Power  and
P. J. Cowen
A. C. Power
Affiliation:
Warneford Hospital, Oxford
P. J. Cowen*
Affiliation:
Littlemore Hospital, Oxford OX4 4XN
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Extract

“In the practical decisions of life it will scarcely ever be possible to go through all the arguments in favour of or against one possible decision, and one will therefore always have to act on insufficient evidence” Werner Heisenberg (1962).

The development of selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs) has added a new dimension to the pharmacotherapy of depression. Their lack of sedative and anticholinergic effects together with relative safety in overdose, has led some authors to suggest that the older tricyclic antidepressants (TCAs) should not now be considered a first-line treatment (Montgomery, 1988). However, since a report by Teicher et al (1990) of suicidal preoccupation associated with fluoxetine treatment, there has been both intense media interest and animated correspondence in clinical and scientific journals (O'Donnell, 1991).

Type
Annotation
Information
The British Journal of Psychiatry , Volume 161 , Issue 6 , December 1992 , pp. 735 - 741
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, L., Angrist, B., Peselow, E., et al (1986) A controlled assessment of propranolol in the treatment of neuroleptic induced akathisia. British Journal of Psychiatry, 149, 42–45.CrossRefGoogle ScholarPubMed
Altamura, A. C., Montgomery, S. A. & Wernicke, J. F. (1988) The evidence for 20 mg a day of fluoxetine as the optimal dose in the treatment of depression. British Journal of Psychiatry, 153 (suppl. 3): 109–112.CrossRefGoogle Scholar
Baldessarini, R. J., Marsh, E. R. & Kula, N. S. (1992) Interactions of fluoxetine with metabolism of dopamine and serotonin in rat brain regions. Brain Research, 579, 152–156.CrossRefGoogle ScholarPubMed
Baldwin, D., Bullock, T., Montgomery, D., et al (1991a) 5-HT reuptake inhibitors, tricyclic antidepressants and suicidal behaviour. International Clinical Psychopharmacology, 6 (suppl. 3): 49–56.CrossRefGoogle ScholarPubMed
Baldwin, D., Fineberg, N. & Montgomery, S. (1991b) Fluoxetine, fluvoxamine and extrapyramidal tract disorders. International Clinical Psychopharmacology, 6, 51–58.CrossRefGoogle ScholarPubMed
Balon, R. (1991) Fluoxetine and preoccupation with suicide (letter). American Journal of Psychiatry, 148, 1260.CrossRefGoogle Scholar
Beasley, C. M., Dornseif, B. E., Bosonworth, J. C., et al (1991) Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. British Journal of Psychiatry, 303, 685–692.Google ScholarPubMed
Beasley, C. M., Potvin, J. H., Masica, D. N., et al (1992) Fluoxetine: no association with suicidality in obsessive compulsive disorder. Journal of Affective Disorders, 24, 1–10.CrossRefGoogle ScholarPubMed
Bergstrom, R. F., Lemberger, L., Farid, N. A., et al (1988) Clinical pharmacology and pharmacokinetics of fluoxetine: a review. British Journal of Psychiatry, 153 (suppl. 3): 47–50.CrossRefGoogle Scholar
Berkley, R. B. (1990) Discussion of fluoxetine and suicidal tendencies (letter). American Journal of Psychiatry, 147, 1572.Google Scholar
Brewerton, T. D. (1991) Fluoxetine induced suicidality, serotonin and seasonality. Biological Psychiatry, 30, 190–196.CrossRefGoogle ScholarPubMed
Burton, S. W. (1991) A review of fluvoxamine and its uses in depression. International Clinical Psychopharmacology, 6 (suppl. 3): 1–21.CrossRefGoogle ScholarPubMed
Charney, D. S., Heninger, G. R. & Sternberg, D. E. (1984) Serotonin function and the mechanism of action of antidepressant treatment: effects of amitriptyline and desipramine. Archives of General Psychiatry, 41, 359–365.CrossRefGoogle ScholarPubMed
Chouinard, G. (1991) Fluoxetine and preoccupation with suicide (letter). American Journal of Psychiatry, 148, 1258–1259.CrossRefGoogle Scholar
Committee on Safety of Medicines (1989) Fluvoxamine and fluoxetine – interaction with monoamine oxidase inhibitors, lithium and tryptophan. Current Problems (May).Google Scholar
Committee on Safety of Medicines (1992) Safety of fluoxetine (Prozac): comparison with fluvoxamine (Faverin). Current Problems (June). Consumers' Association (1992) Fluoxetine, suicide and aggression. Drug and Therapeutics Bulletin, 30, 5–6.Google Scholar
Cooper, G. L. (1988) The safety of fluoxetine – an update. British Journal of Psychiatry, 153 (suppl. 3): 77–86.CrossRefGoogle Scholar
Cowen, P. J. (1988) Prolactin response to tryptophan during mianserin treatment. American Journal of Psychiatry, 145, 740–741.Google ScholarPubMed
Cowen, P. J. (1990) Personality disorders: are drugs useful? In Dilemmas and Difficulties in the Management of Psychiatric Patients (eds K. Hawton & P. Cowen), pp. 105–116. Oxford: Oxford University Press.Google Scholar
Cowen, P. J. (1991) Serotonin receptor subtypes: implications for psychopharmacology. British Journal of Psychiatry, 159 (suppl. 12): 7–14.CrossRefGoogle Scholar
Cowen, P. J., McCance, S. L., Ware, C. J., et al (1991) Lithium in tricyclic-resistant depression: correlation of increased brain 5-HT function with clinical outcome. British Journal of Psychiatry, 159, 341–346.CrossRefGoogle ScholarPubMed
Creaney, W., Murray, I. & Healy, D. (1991) Antidepressant induced suicidal ideation. Human Psychopharmacology, 6, 329–332.CrossRefGoogle Scholar
Damluji, N. F. & Ferguson, J. M. (1988) Paradoxical worsening of depressive symptomatology caused by antidepressants. Journal of Clinical Psychopharmacology, 8, 347–349.CrossRefGoogle ScholarPubMed
Dasgupta, K. (1990) Additional cases of suicidal ideation associated with fluoxetine (letter). American Journal of Psychiatry, 147, 1570.CrossRefGoogle Scholar
Doogan, D. P. & Caillard, V. (1988) Sertraline: a new antidepressant. Journal of Clinical Psychiatry, 49 (suppl. 8): 46–51.Google ScholarPubMed
Dornseif, B. E., Dunlop, S. R., Potvin, J. H., et al (1989) Effect of dose escalation after low dose fluoxetine therapy. Psychopharmacology Bulletin, 25, 71–79.Google ScholarPubMed
Drake, R. E. & Ehrlich, J. (1985) Suicide attempts associated with akathisia. American Journal of Psychiatry, 142, 499–501.Google ScholarPubMed
Dunbar, G. C., Cohn, J. B., Fabre, L. F., et al (1991) A comparison of paroxetine, imipramine and placebo in depressed outpatients. British Journal of Psychiatry, 159, 394–398.CrossRefGoogle Scholar
Fava, M. & Rosenbaum, J. F. (1991) Suicidality and fluoxetine: is there a relationship? Journal of Clinical Psychiatry, 52, 108–111.Google ScholarPubMed
Feighner, J. P., Boyer, W. F., Tyler, D. L., et al (1990) Adverse consequences of fluoxetine–MAOI combination therapy. Journal of Clinical Psychiatry, 51, 222–225.Google ScholarPubMed
Fluoxetine Bulimia Nervosa Collaborative Study Group (1992) Fluoxetine in the treatment of bulimia nervosa: a multi-centre placebo controlled double-blind trial. Archives of General Psychiatry, 49, 139–147.CrossRefGoogle Scholar
Glennon, R. A., Darmani, N. A. & Martin, B. R. (1991) Multiple populations of serotonin receptors may modulate the behavioural effects of serotonergic agents. Life Sciences. 48, 2493–2498.CrossRefGoogle ScholarPubMed
Golden, R. N., Gilmore, J. H., Corrigan, M. H., et al (1991) Serotonin, suicide and aggression: clinical studies. Journal of Clinical Psychiatry, 52 (suppl. 12): 61–69.Google ScholarPubMed
Goodwin, G. M., Green, A. R. & Johnson, P. (1984) 5-HT2 receptor characteristics in frontal cortex and 5-HT2 receptor-mediated head-twitch behaviour following antidepressant treatment to mice. British Journal of Pharmacology, 83, 235–245.CrossRefGoogle ScholarPubMed
Goodwin, G. M., Green, A. R. (1985) A behavioural and biochemical study in mice and rats of putative selective agonists and antagonists for 5-HT1 and 5-HT2 receptors. British Journal of Pharmacology, 84, 743–753.CrossRefGoogle Scholar
Grahame-Smith, D. G. (1971) Studies in vivo on the relationship between brain tryptophan, brain 5-HT synthesis and hyperactivity in rats treated with a monoamine oxidase inhibitor and l-tryptophan. Journal of Neurochemistry, 18, 1053–1066.CrossRefGoogle ScholarPubMed
Gudelsky, G. A., Koenig, J. I. & Meltzer, H. Y. (1986) Thermoregulatory responses to serotonin (5-HT) receptor stimulation in the rat: evidence for opposing roles of 5-HT2 and 5-HT1A receptors. Neuropharmacology, 25, 1307–1313.CrossRefGoogle Scholar
Healy, D. & Creaney, W. (1991) Fluoxetine and suicide (letter). British Medical Journal, 303, 1058–1059.CrossRefGoogle Scholar
Heisenberg, W. (1962) Physics and Philosophy. New York: Harper & Row. (Published 1989, Harmondsworth: Pelican Books, citation from p. 182.)Google Scholar
Hoyer, D. (1988) Functional correlates of serotonin 5-HT, recognition sites. Journal of Receptor Research, 8, 59–81.CrossRefGoogle ScholarPubMed
Insel, T. R., Roy, B. F., Cohen, R. M., et al (1982) Possible development of the serotonin syndrome in man. American Journal of Psychiatry, 139, 954–955.Google ScholarPubMed
Johnson, A. M. (1991) The comparative pharmacological properties of selective serotonin re-uptake inhibitors in animals. In Selective Serotonin Re-uptake Inhibitors (eds J. P. Feighner & W. F. Boyer), pp. 37–71. Chichester: Wiley.Google Scholar
Katz, R. J. (1980) Role of serotonergic mechanisms in animal models of predation. Progress in Neuropsychopharmacology, 4, 219–231.CrossRefGoogle ScholarPubMed
Lee, M. A., Nash, J. F., Barnes, M., et al (1991) Inhibitory effect of ritanserin on the 5-hydroxytryptophan mediated Cortisol ACTH and prolactin secretion in humans. Psychopharmacology, 103, 258–264.CrossRefGoogle ScholarPubMed
Lindgren, T. & Kantak, K. M. (1987) Effects of serotonin receptor agonists and antagonists on offensive aggression in mice. Aggressive Behaviour, 13, 87–96.3.0.CO;2-0>CrossRefGoogle Scholar
Lipinski, J. F., Mallya, G., Zimmerman, P., et al (1989) Fluoxetine-induced akathisia: clinical and theoretical implications. Journal of Clinical Psychiatry, 50, 339–342.Google ScholarPubMed
Mann, J. J. & Kapur, S. (1991) The emergence of suicidal ideation and behaviour during antidepressant pharmacotherapy. Archives of General Psychiatry, 48, 1027–1033.CrossRefGoogle ScholarPubMed
Marley, E. & Wozniak, K. M. (1984) Interactions of a nonselective monoamine oxidase inhibitor, phenelzine, with inhibitors of 5-hydroxytryptamine, dopamine or noradrenaline re-uptake. Journal of Psychiatry Research, 18, 173–189.CrossRefGoogle ScholarPubMed
Marsden, C. D. & Jenner, P. (1980) The pathophysiology of extrapyramidal side-effects of neuroleptic drugs. Psychological Medicine, 10, 55–72.CrossRefGoogle ScholarPubMed
Masand, P., Gupta, S. & Dewan, M. (1991) Suicidal ideation related to fluoxetine treatment (letter). New England Journal of Medicine, 324, 420.Google Scholar
Meltzer, H. Y. (1990) The role of serotonin in depression. Annals of the New York Academy of Sciences, 600, 486–500.CrossRefGoogle ScholarPubMed
Montgomery, S. A. (1988) The benefits and risks of 5-HT uptake inhibitors in depression. British Journal of Psychiatry, 153 (suppl. 3): 7–10.CrossRefGoogle Scholar
Muijen, N., Roy, D., Silverstone, T., et al (1988) A comparative clinical trial of fluoxetine, mianserin and placebo in depressed patients. Acta Psychiatrica Scandinavica, 78, 384–390.CrossRefGoogle Scholar
O'Donnell, M. (1991) Trial by anecdote. British Medical Journal, 302, 56–57.Google Scholar
Oswald, I. (1991) Fluoxetine and suicide (letter). British Medical Journal, 303, 1058.Google Scholar
Parent, A., Dascarries, L. & Beaudet, A. (1981) Organization of ascending serotonin systems in the adult rat brain. A radioautographic study after intraventricular administration of (3H)5-hydroxytryptamine. Neuroscience, 6, 115–138.CrossRefGoogle Scholar
Peroutka, S. J. & Snyder, S. H. (1980) Long-term antidepressant treatment decreases spiroperidol-labelled serotonin receptor binding. Science, 210, 88–91.CrossRefGoogle ScholarPubMed
Price, L. H., Charney, D. S., Delgado, P. L., et al (1989) Effects of desipramine and fluvoxamine treatment on the prolactin response to tryptophan. Archives of General Psychiatry, 46, 625–631.CrossRefGoogle ScholarPubMed
Rothschild, A. J. & Locke, C. A. (1991) Re-exposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia. Journal of Clinical Psychiatry, 52, 491–493.Google Scholar
Rouillon, F., Phillips, R., Serrurier, D., et al (1989) Rechutes de depression unipolaire à et efficacite de la maprotiline. Encephale, 15, 527–534.Google Scholar
Sacchetti, E., Guarneri, L. & Cornacchia, M. (1991) The effectiveness of fluoxetine, clomipramine, nortriptyline and desipramine in major depressives with suicidal behaviour: preliminary findings. In Serotonin-Related Psychiatric Syndromes: Clinical and Therapeutic Links (eds G. B. Cassano & H. S. Akiskal), International Congress and Symposium Series, No. 165, pp. 47–53. London: Royal Society of Medicine Services.Google Scholar
Sachdev, P. & Loneragan, C. (1991) The present status of akathisia. Journal of Nervous and Mental Disease, 179, 381–391.CrossRefGoogle ScholarPubMed
Schweizer, E., Rickels, K., Amsterdam, J. D., et al (1990) What constitutes an adequate antidepressant trial for fluoxetine? Journal of Clinical Psychiatry, 51, 8–11.Google ScholarPubMed
Shear, M. K., Frances, A. & Weiden, P. (1983) Suicide associated with akathisia and depot fluphenazine treatment. Journal of Clinical Psychopharmacology, 3, 235–236.CrossRefGoogle ScholarPubMed
Steiner, W. & Fontaine, R. (1986) Toxic reaction following the combined administration of fluoxetine and l-tryptophan: five case reports. Biological Psychiatry, 21, 1067–1071.CrossRefGoogle ScholarPubMed
Sternbach, H. (1991) The serotonin syndrome. American Journal of Psychiatry, 148, 705–713.Google ScholarPubMed
Stoll, A. L., Hope, H. G. & McElroy, S. L. (1991) High dose fluoxetine: safety and efficacy in 27 cases. Journal of Clinical Psychopharmacology, 11, 225–226.CrossRefGoogle ScholarPubMed
Teicher, M. H., Glod, C. & Cole, J. O. (1990) Emergence of intense suicidal preoccupation during fluoxetine treatment. American Journal of Psychiatry, 147, 207–210.Google ScholarPubMed
Tollefson, G. D. (1990) Fluoxetine and suicidal ideation (letter). American Journal of Psychiatry, 147, 1691–1692.Google Scholar
Ugedo, L., Grenhoff, J. & Svensson, T. H. (1989) Ritanserin, a 5-HT2 receptor antagonist, activates mid brain dopamine neurones by blocking serotonergic inhibition. Psychopharmacology, 98, 45–50.CrossRefGoogle ScholarPubMed
van Praag, H. M. (1991) Serotonergic dysfunction and aggression control. Psychological Medicine, 21, 15–19.CrossRefGoogle ScholarPubMed
van Putten, T. (1975) The many faces of akathisia. Comprehensive Psychiatry, 16, 43–47.CrossRefGoogle ScholarPubMed
Wirshing, W. C., van Potter, T., Rosenberg, J., et al (1992) Fluoxetine, akathisia and suicidality: is there a causal connection? Archives of General Psychiatry, 49, 580–581.Google Scholar
Zubenko, G. S., Cohen, B. M. & Lipinski, J. F. (1987) Antidepressant-induced akathisia. Journal of Clinical Psychopharmacology, 7, 254–257.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.