SSRI (Selective Serotonin Reuptake Inhibitor)
Selective serotonin reuptake inhibitor (SERT) with additional 5-HT2C receptor antagonism, enhancing serotonergic neurotransmission and modulating anxiety and mood.
Major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, premenstrual dysphoric disorder (PMDD)
Binge eating disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SoAD), generalized anxiety disorder (GAD), post-stroke affective lability, post-stroke depression (PSD), depression in Parkinson’s disease (PD), depression in dementia, agitation and aggression in neurodevelopmental disabilities
Oral capsules, tablets, liquid solution (10 mg, 20 mg, 40 mg)
10–20 mg p.o. daily, titrating gradually based on clinical response and tolerability
20–80 mg/day
Long half-life (~2–4 days) with active metabolite norfluoxetine (half-life ~7–15 days); steady state reached in several weeks; metabolized primarily via CYP2D6
Insomnia, nausea, headache, sexual dysfunction, weight loss
Serotonin syndrome (especially with other serotonergic agents), increased risk of bleeding, hyponatremia, QTc prolongation (lower risk compared to other SSRIs)
Monitor for serotonin syndrome symptoms, suicidality, and adverse effects; ECG monitoring if combined with QT-prolonging drugs or cardiac risk factors
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Fluoxetine is generally considered safe in patients with seizure disorders but may lower the seizure threshold; monitoring is recommended. It can effectively treat depressive symptoms in neurodegenerative disorders such as Parkinson’s disease (PD) and dementia, but should be used cautiously in dementia due to potential exacerbation of agitation or cognitive decline. In elderly patients, fluoxetine is typically well tolerated; however, dose reductions may be necessary in those with severe hepatic impairment. Its long half-life and active metabolite can reduce withdrawal symptoms but complicate cross-tapering when switching antidepressants.