J Am Acad Child Adolesc Psychiatry. 1991 Mar;30(2):179-86.

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        J Am Acad Child Adolesc Psychiatry. 1991 Sep;30(5):849-50.

        J Am Acad Child Adolesc Psychiatry. 1991 Sep;30(5):850-1.

Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment.

King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, Lombroso P, Scahill L.

Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06510-8009.

Self-injurious ideation or behavior appeared de novo or intensified during fluoxetine treatment of obsessive-compulsive disorder in six patients, age 10 to 17 years old, who were among 42 young patients receiving fluoxetine for obsessive-compulsive disorder at a university clinical research center. These symptoms required the hospitalization of four patients. Before receiving fluoxetine, four patients had major risk factors for self-destructive behavior including depression or prior suicidal ideation or self-injury. Three hypotheses concerning the apparent association between fluoxetine and these self-injurious phenomena are discussed: (1) coincidence; (2) disorganization of vulnerable individuals secondary to drug-induced activation; and (3) a specific serotonergic-mediated effect on the regulation of aggression.