Akathisia, suicidality, and fluoxetine.
BACKGROUND
The propose link between fluoxetine and suicidal ideation is explained by fluoxetine-induced akathisia and other dysphoric extrapyramidal reactions.


METHODS
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.


CONCLUSIONS
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.
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York.
M S
MS
Hamilton
L A
LA
Opler
D017109:Akathisia, Drug-Induced / Q000209:etiology / Q000523:psychology*; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000139:chemically induced / Q000503:physiopathology / Q000523:psychology; D005473:Fluoxetine / Q000009:adverse effects*; D006801:Humans; D008959:Models, Neurological; D008960:Models, Psychological; D012701:Serotonin / Q000502:physiology; D013405:Suicide / Q000523:psychology*
D005473:Fluoxetine; D012701:Serotonin