Could SSRI´s cause aggression?/nAre there any different effects among SSRI´s in the appearance of a

Fråga: Could SSRI´s cause aggression? Are there any different effects among SSRI´s in the appearance of aggression? Background: Three patients have become aggressive after the treatment of anxiety and depressive symptoms with SSRI´s. All of these patients had histories of drug abuses with central stimulants (cocaine and amphetamine). In FASS, agitation is documented as an adverse effects of SSRI´s, but the symptoms have been more than agitation.

Sammanfattning: Meta-analysis did not show that a SSRI´s is associated with an increased risk of violent or aggressive behavior, but the possibility of rare adverse effect is not excluded.

Svar: Many studies in humans and animals have shown a specific relationship between aggression and CNS serotonin dysfunctions. These studies have shown that treatments which increase net 5-HT activity decrease aggressive behaviors, including suicidality (1,2).

However, recent published reports have suggested that a paradoxical worsening of aggressive behavior including suicidality, may occur in patients associated with the use of SSRI´s (3,4,5,6,7,8). All of them were case reports with the use of fluoxetine or fluvoxamine, and suggested that SSRI´s can induce aggressive behavior in a small minority of patients. On the other hand, the recent results of the meta-analysis of the United States Investigational New Drug Clinical Trial Databases indicated that there was no causal relationship between fluoxetine and self- and other-directed aggression or violence (9). They reported that fluoxetine-treated patients (0.15 per cent) experienced significantly less aggression than placebo-treated patients (0.65 per cent). So far, there have been several reports on the use of SSRI´s in patients with histories of drug abuses including cocaine and amphetamine in the literature (10,11,12,13), but we have not been able to find any studies on increasing event of aggression in these patients.

Among the SSRI´s, Fisher et al showed in the postmarketing surveillance that fluoxetine-treated patients (1.4 per cent) reported an increased frequency of aggression compared to sertraline-treated patients (0.74 per cent), but total adverse reaction of fluoxetine was lesser than that of sertraline (14).