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.
Hamilton
M S
MS
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York.
Opler
L A
LA
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