Severe disturbance occurring during treatment for depression of a bulimic patient with fluoxetine.

We report on a 32-year old woman with bulimia nervosa treated with fluoxetine for depression. Fluoxetine is the only drug currently recommended for the treatment of bulimia. The patient became severely disturbed with tension, irritability, self-damage by cutting and violent, intense, suicidal and paranoid ideation qualitatively different to previous symptoms in the course of her illness. Clinical impression was of a striking association between fluoxetine and these symptoms. We suggest caution when using fluoxetine in bulimic patients with depression who have additional impulsive behaviours such as self-cutting, alcohol and/or drug abuse and shop-lifting.