Despite the time that has elapsed, it is still a very effective drug and from my perspective it is among the 5 antidepressants of first choice for the treatment of major depression. As it has been known for more than 30 years, it enjoys wide security and this is supported by a multitude of studies carried out since its massive prescription began in the general population. In fact, to date there are no studies that indicate the existence of serious adverse effects in its continued use over long periods of time, although we do have evidence of a certain loss of effect when it is administered for years. Nor is there much evidence in various meta-analyses that the suspension of fluoxetine in very prolonged treatments carries a greater associated risk of relapse.
From an eminently clinical point of view, despite the enormous offer of new antidepressants that compete with it, it continues to be one of the main choices in the treatment of depression. Its combination of safety, high efficacy, good tolerance and very low cost justify the generalization of its use, even ahead of the novelties that are introduced annually in the antidepressant market. The only perhaps worrying point about this molecule is that it has been speculated that it could increase the level of irritability in some isolated patients and therefore be responsible for an increased risk of suicide, particularly in children and adolescents. My perception is that although there are isolated cases of irritability that are difficult to attribute to the drug, because depressive pathology sometimes presents with irritability, we have not found any casuistry that corroborates this statement and we have not observed this circumstance in our clinical practice. Therefore, it continues to be one of the best antidepressant drugs known to date.
Lastly, it is necessary to emphasize that our view of the drug is largely the result of accumulated clinical experience and therefore, is not exempt from subjectivity. Consequently, this guide is intended to fulfill a merely indicative function, particularly for the use of the drug by non-medical healthcare providers and patients.
Dr Ponce, psychiatrist