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Comment in:
Unexpected deaths in depressed medical inpatients treated
with fluoxetine.
Spier SA, Frontera
MA.
Psychiatric Consultation Service, Mercy Medical Center,
Baltimore, MD 21202.
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. METHOD:
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.
Publication Types:
PMID: 1894590 [PubMed - indexed for
MEDLINE]
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