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

J Am Acad Child Adolesc Psychiatry. 1991 Mar;30(2):179-86. doi: 10.1097/00004583-199103000-00003.


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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Clinical Trials as Topic
  • Double-Blind Method
  • Female
  • Fluoxetine / adverse effects*
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / drug therapy*
  • Obsessive-Compulsive Disorder / psychology
  • Placebos
  • Self Mutilation / chemically induced*
  • Suicide / psychology*


  • Placebos
  • Fluoxetine