Reports of SSRI-Induced Obsessive Suicidality and Aggression in Adults

Case Reports of SSRI-induced Obsessive Suicidality and Aggression in Adults 

A number of clinical reports have described a syndrome of obsessive SSRI-induced suicidality and aggression that seems particular to these drugs, starting with Teicher et al. (1990). These cases bear some similarity to akathisia-driven suicidality, but compulsion toward self-harm is not accompanied by the specific symptoms of akathisia. They summarized, Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment (p. 207). Additional cases and potential mechanisms of action were analyzed by Teicher et al. (1993). 

Dasgupta (1990) described a similar case of intense suicidal preoccupation (p. 1570) after 4 weeks of fluoxetine treatment in a woman who had not been previously suicidal. She, too, rapidly recovered on stopping the fluoxetine. Hoover (1990) described another similar case in which the patient developed intense, violent suicidality on the two occasions that he was exposed to fluoxetine. 

Creaney et al. (1991) described two patients who became suicidal on SSRIs. One patient developed dysphoria and manic symptoms on fluoxetine and then developed a similar syndrome, this time with suicidal feelings, on fluvoxamine. Another patient became intensely and violently suicidal 16 days after starting fluoxetine. 

Gualtieri (1991) described the case of a mentally handicapped gentleman whose rates of self-injurious behavior doubled on fluoxetine, and then fell to baseline after the drug was withdrawn (p. 393). Gualtieri pointed out that fluoxetine can cause apathy and indifference in some patients and, conversely, mania in others. 

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