Selective resolution of bulimic symptoms and increased suicidal behaviour in an adolescent during fluoxetine treatment.

The case of a 15-year-old girl is reported, who suffered from depression and comorbid bulimia nervosa. Her suicidal behaviour worsened with parallel improvement of bulimic symptoms during fluoxetine treatment. These symptoms reversed after the medication was changed to mirtazapine and quetiapine. The small dose of quetiapine was used as an adjunct to the antidepressant treatment, and it resulted in dramatic improvement of mood, cessation of suicidal ideation and return of normal psychosocial functioning. It is suggested that the anti-bulimic effect of fluoxetine is independent of the antidepressant effect. Worsening of suicidal symptoms during fluoxetine treatment warrants a change of antidepressant. Qutiapine may be useful as an adjunct to antidepressants in the management of treatment resistant depression. [ABSTRACT FROM AUTHOR]