氟西汀导致自杀？

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刚开始服用氟西汀是不是能增加焦虑啊？！自杀观念增加。
我吃文拉发欣基本是最大量，半年左右。效果不是太稳定，但是也有好的时候。自从加了一个20毫克的氟西汀到第四天开始情绪低落，焦虑，反映迟钝，自杀念头很明显。我现在时二次发病了，这种自杀的想法从来都没有出现过。为什么吃了氟西汀后会这样？？！是病情自身的反复还是氟西汀的原因？
不过到加氟西汀10天左右时，情绪逐渐好转，没有自杀的念头了。
本想就这样向好的方向发展下去，谁知道加氟西汀20天左右时，出现了类似5羟色胺综合症的症状，震颤，肌阵挛，恶心，紧咬牙关等症状。
因为我吃的药量比较大，225毫克文拉发新+20毫克的氟西汀。这时候氟西汀的药效上来了，所以就出现这种情况。
马上把文拉发新全部停掉了，感觉还不错，不过只维持一天半的好状态，昨天晚上开始出现断药现象，恶心的很，难受的要命，就马上吃了150的宜诺斯，过了一会，就不难受了，但是晚上睡觉时震颤，肌阵挛的很厉害，肌肉一直在跳。
看有人说氟西汀和文拉发新联合用药必定会得 5羟色胺综合症。是真的吗？
我现在是骑虎难下了，如果吃文拉发新就会有5羟色胺的危险，如果不吃就有断药的副作用。真不知道该怎么办？
我也想过把氟西汀停掉，只吃文拉发新，恢复到以前的情况，但是只吃文拉发新就是最大量还是时好时坏，不稳定，怎么办啊？愁死了！！！
昨晚睡的不好，因为肌肉一直跳，今天早上好多了。我想要不今天就吃75毫克的宜诺斯试试看。
没办法，只能把自己当小白鼠做实验了。唉，命苦哦！！！

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大家帮帮忙哦

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3# 砚谷墨清

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3# 砚谷墨清 哦，谢谢你。

晔阳

氟西汀的确有因其自杀意念的报道。遇到此类问题，一般是你的抑郁症状没得到很好的控制，并且伴有肌肉运动方面的问题。可能是药物抑制了多巴胺的释放。不管如何，应该速找医生重新评价你的治疗方案。切不可疏忽！！

Prescriber Update Articles
Agitation, Restlessness and Suicidal Behaviour with Fluoxetine, Paroxetine and Sertraline

ADR Update

Website: September 2002
Prescriber Update 2002;23(3):37-38

Professor Pete Ellis, Psychiatrist, Department of Psychological Medicine, Wellington School of Medicine.


There have been rare reports of fluoxetine and, more recently, paroxetine and sertraline being associated with aggressive or suicidal thoughts and behaviour.  Due to similar pharmacological profiles, the same reactions may occur with other selective serotonin re-uptake inhibitors (SSRIs).  It is possible that these reactions can be attributed to akathisia (involuntary severe motor restlessness).  However, the most common reason for self-harm behaviour during treatment with any antidepressant is worsening depression.  The development of severe agitation or self-harm behaviour is an indication that the patient and their antidepressant therapy require prompt review.  Patients should be advised to seek medical attention as soon as possible if they develop agitation or restlessness, or if their depression worsens.

Reports of aggressive and suicidal behaviour with SSRIs investigated
Behaviour change may be due to SSRI-induced akathisia
Agitation or harmful behaviour signals need to review both patient and treatment immediately
Informing patients to seek help may help reduce adverse outcomes
References
Reports of aggressive and suicidal behaviour with SSRIs investigated

Soon after the introduction of fluoxetine internationally, it was claimed to cause suicidal thinking and behaviour.1  This allegation was investigated by a number of regulatory agencies, including the Food and Drug Administration in the United States in 1991, and was not substantiated.  More recently, there have been several further case reports, some given media prominence, and some leading to legal proceedings, not only in relation to fluoxetine2,3 but also to paroxetine and sertraline.4-6  Systematic reviews continue to support the view that selective serotonin re-uptake inhibitors (SSRIs) are effective and are not associated with increased suicidality or increased violence.7  However, these reports1-6 raise questions about whether the small group of patients experiencing the rare side effect of akathisia are at increased risk of suicide.
Behaviour change may be due to SSRI-induced akathisia

Detailed case reports1,4 describe the emergence of marked restlessness and agitation, followed by suicidal thinking or behaviour, in patients soon after commencing fluoxetine or other serotonergic agents.  This restlessness and agitation may reflect akathisia (involuntary severe motor restlessness).  Although more commonly associated with antipsychotics, reflecting dopamine receptor blockade, interactions between the serotonergic and dopaminergic systems may account for akathisia also occurring with SSRIs.8-10  A putative link between akathisia and suicidal behaviour is less clear, and not all of the more recent case reports describe preceding restlessness.1,4  Older groups of antidepressants have also been associated with increased suicidal thinking and behaviour, although not related to increased restlessness.11
Agitation or harmful behaviour signals need to review both patient and treatment immediately

The key issues in treating depression are the selection of an appropriate treatment in conjunction with the depressed person, and the use of an adequate dose for an adequate length of time, along with attention to current stressors.  The most common reason for suicidal ideation or behaviour during treatment with any antidepressant remains worsening depression.  The development of agitation or self-harm behaviour (from any cause) indicates the need to increase support to ensure the patient's safety, as well as a review of treatment to check that it is optimised for that person.
Informing patients to seek help may help reduce adverse outcomes

As with many medicines, rare serious side effects may emerge during treatment and patients should be aware of these and what action to take.  It is recommended that all patients taking SSRIs should be advised that if they become particularly agitated or restless, they should seek medical advice and stop their antidepressant in the interim.  In addition, any serious worsening of their symptoms, particularly in relation to suicidal thoughts, should be reported urgently to their treating doctor (or on-call colleague).  Severe agitation, severe restlessness/akathisia, and/or increased suicidality with SSRIs have been added as adverse reactions of current concern.

Competing interests (author): the author is supervising a PhD student whose research has been funded by Eli Lilly.  He has accepted invitations from pharmaceutical companies to speak at several meetings relating to prescribing in general, as well as other topics.  He has a beneficial interest in shares of certain pharmaceutical companies, including some who manufacture antidepressants, including SSRIs.

Correspondence to Professor Pete Ellis, Department of Psychological Medicine, Wellington School of Medicine, PO Box 7343, Wellington South. E-mail: ellis@wnmeds.ac.nz
References

   1. Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990;147:207-210.
   2. Leon AC, Keller MB, Warshaw MG, et al. Prospective study of fluoxetine treatment and suicidal behavior in affectively ill subjects. Am J Psychiatry 1999;156:195-201.
   3. Healy D, Langmaak C, Savage M. Suicide in the course of treatment of depression. J Psychopharmacology 1999;13:94-99.
   4. Healy D. Emergence of antidepressant induced suicidality. Primary Care Psychiatry 2000;6:23-28.
   5. Jackson A. Two years' jail for anti-depressant killer. Sydney Morning Herald 24 May 2001 www.smh.com.au/news/0105/24/update/news108.html
   6. Bosely S. Murder, suicide. A bitter aftertaste for the 'wonder' depression drug. Guardian 11 June 2001 www.guardian.co.uk/Archive?article?0,4273,4201752,00.html
   7. Walsh M-T, Dinan TG. Selective serotonin reuptake inhibitors and violence: a review of the available evidence. Acta Psychiatr Scand 2001;104:84-91.
   8. Teicher MH, Glod C, Cole JO. Antidepressant drugs and the emergence of suicidal tendencies. Drug Safety 1993;8:186-212.
   9. Power AC, Cowen PJ. Fluoxetine and suicidal behaviour. Some clinical and theoretical aspects of a controversy. Br J Psychiatry 1992;161:735-741.
  10. Tueth MJ. Revisiting fluoxetine (Prozac) and suicidal preoccupations. J Emergency Med 1994;12:685-687.
  11. Macleod AD. Paradoxical responses to antidepressant medications. Ann Clin Psychiatry 1991;3:239-242.

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6# 晔阳 谢谢

天堂无门

这些抗抑郁的药说明书上都写着。服用初期可能会增加自杀的风险

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大家好！好开心哦！这两天状况好了起来！看来是选对药了。感觉已经恢复了。

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还是225毫克的文拉发辛加20毫克的氟西汀。虽然药量比较大，但是现在没有感到什么明显得副作用。只要能开开心心的，别的什么都不重要！