Friend asks: is prozac (fluoxetine) safe for my 17 yo daughter at risk for self harm, with eating disorder and depression? does prozac (fluoxetine) increase suicidal ideation?

Careful!: ANY anti-depressant is dangerous in patient's with suicidal ideation. This is particularly true in patient's with co-morbid or dual diagnosis histories. I would not use Prozac (fluoxetine) since it can cause hyperactivity, thus increased self harm behavior.

Less likely: As a SSRI anti depressant I think it is a better choice for treatment. Underlying co morbidity can sometimes result in such ideation, not necessarily drug induced.Occasional hallucinations are reported as a side effect, again may contribute to such ideation. But as a drug we use that in pediatrics, so do my psychiatry colleagues fairly frequently. I would say it is safe with counselling.

PROZAC (fluoxetine) PLUS THERAPY: The most optimal combination for emotional problems is meds and psychotherapy. That being said, be mindful that meds by themselves only take the edge off symptoms; alone they solve nothing. The real grunt work takes place in the psychotherapist's office.