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February 7, 1991
Author: New York Times News Service.
Doctors have reported two more cases of suicidal behavior and suicidal fantasies that they believe can only be explained by the effects of the widely publicized anti-depressant drug Prozac.
The new cases were described in a letter in Thursday’s issue of The New England Journal of Medicine [See below]. The physicians said the two cases differed from previous published reports of suicidal behavior linked to Prozac because the two patients had never before shown signs of wanting to kill themselves.
But Eli Lilly and Co. of Indianapolis, maker of Prozac, as well as many other physicians, deny there is any scientific merit to the charge that the drug can prompt suicidal or violent acts. The company argues its product is, in fact, less likely to make patients suicidal than other anti-depressants.
Prozac, the commercial form of the compound fluoxetine, is already the center of a sharp legal and medical dispute.
More than 50 lawsuits have been filed against Lilly. One involves former rock star Del Shannon, who was taking Prozac when he committed suicide in Los Angeles last year.
Like most of the others, the suit by Shannon’s wife, Leanne Westover, charges the pharmaceutical company with “improper testing” of Prozac and “a failure to warn the medical community of the dangerous propensities that Prozac can produce in a small number of cases”, said Leonard Finz, a New York lawyer, the lead counsel in the Shannon case and now the most prominent legal crusader against Prozac.
Record Number: CTR9101120010
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Suicidal Ideation Related To Fluoxetine Treatment — (New England Journal of Medicine NEJM Vol. 324 No. 6)
February 7, 1991
To the Editor: Fluoxetine (Prozac) is a commonly prescribed antidepressant. Recent concern has emerged regarding its ability to induce suicidal ideation.’
We report on two patients in whom suicidal ideation and fluoxetine treatment were strongly associated. A 58-year-old man with a 13-year history of major depression (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised), whose previous two episodes had responded to imipramine, was admitted with an episode of depression refractory to imipramine. He was started on fluoxetine (20 mg daily). Three days later he had violent suicidal thoughts and tried to hang himself with a rope.
The fluoxetine was discontinued, with complete disappearance of suicidal ideation four days later. The depression was successfully treated with electroconvulsive therapy.
A 28-year-old woman with a history of bulimia nervosa and major depression was admitted to the hospital. Two months before admission she had been started on fluoxetine (20 mg daily), which was increased over a one-week period to 60 mg daily. Over the next week she had akathisia2 (motor restlessness) and recurrent suicidal thoughts, fantasizing about jumping out the hospital window. Fluoxetine and alprazolam (2.5 mg daily) were discontinued, and clonazepam (0.5 mg daily) was used to treat her overwhelming anxiety. Three days later her akathisia had resolved, and 10 days later the suicidal ideation ceased.
Teicher et al.1 described six patients in whom violent suicidal preoccupation developed after two to seven weeks of fluoxetine treatment. In contrast to our patients, all theirs had a history of suicidal thoughts or gestures, and in only one case did the suicidal ideation disappear within one week of discontinuation of fluoxetine. Neither of our patients had a diagnosable personality disorder or history of suicidal ideation, gestures, mania, or hypomania. In our patients, the temporal association of suicidal ideation with the initiation of fluoxetine and its rapid disappearance within a week of discontinuing treatment strongly suggest that fluoxetine can induce suicidal ideation in a very small minority of patients. Clinicians should be alert to this possible side effect of fluoxetine, since attributing the effect to depression and increasing the dose may lead to serious consequences.
PRAKASH MASAND, M.D. SANJAY GUPTA, M.D. MANTOSH DEWAN, M.D. State University of New York Syracuse, NY 13210 Health Science Center
1. Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990; 147:207-10. 2. Lipinski JF Jr, Mallya G, Zimmerman P, Pope HG Jr. Fluoxetine-induced akathisia: clinical and theoretical implications. J Clin Psychiatry 1989; 50:339-42.