The Fluoxetine and Suicide Controversy

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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.