Unexpected deaths in depressed medical inpatients treated with fluoxetine.
BACKGROUND
Depression in the medically ill is underdiagnosed and undertreated. Fluoxetine would appear promising in this population because of its efficacy and benign side effect profile, but it has not been systematically studied in the medically ill.


METHODS
The authors report the cases of three seriously medically ill patients, seen in psychiatric consultation while patients on a general medical service, who were treated with fluoxetine for depression. Each was an elderly white female with pulmonary disease and atrial arrhythmias, including atrial fibrillation, and each was prescribed diuretics, nitrates, and other cardiac and/or pulmonary agents.


RESULTS
Each patient died within 10 days of beginning fluoxetine treatment, from unexplained causes.


CONCLUSIONS
The authors hypothesize that direct cardiac effects mediated by fluoxetine, or other factors, may have been contributory. The effects of fluoxetine on electrolytes, fluoxetine's possible effects on drug levels, and serotonin's effect on the pulmonary system are examined. Other antidepressant agents should be considered in this particular population until further data are available.
Spier
S A
SA
Psychiatric Consultation Service, Mercy Medical Center, Baltimore, MD 21202.
Frontera
M A
MA
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000401:mortality; D003645:Death, Sudden / Q000209:etiology*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects* / Q000627:therapeutic use / Q000633:toxicity; D006801:Humans; D007297:Inpatients; D008171:Lung Diseases / Q000150:complications / Q000401:mortality; D008875:Middle Aged; D012017:Referral and Consultation
D005473:Fluoxetine