Reexposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia.

Considerable controversy exists regarding the relationship between fluoxetine and the emergence of suicidal ideation. Three cases are presented of patients who were reexposed to fluoxetine after having previously made a serious suicide attempt during fluoxetine treatment. All three patients developed severe akathisia during retreatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts. The akathisia and suicidal thinking abated upon the discontinuation of the fluoxetine or the addition of propranolol. The emergence of suicidal ideation during treatment with fluoxetine may be secondary to the development of akathisia. Gradual increments of fluoxetine dose and the prompt recognition and treatment of akathisia may reduce further the rare occurrence of suicidal ideation during fluoxetine treatment.