A small number of people taking fluoxetine have experienced intense, violent, suicidal thoughts, agitation, and impulsivity. Whether their symptoms were induced by fluoxetine or were related to their underlying psychological problems is unclear. As with any other antidepressant, fluoxetine should only be used under close medical supervision. Patients are advised to consider telling relatives and friends about their use of this drug and the risk of suicidal obsession and self-injurious behavior.
Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmD MPH, page 235

On September 20, 1991, the FDA held a hearing to discuss a request that warnings be placed upon the labels of Prozac and other antidepressants, which was made by Ralph Nader's health research group, The Public Citizen. They felt that problems were serious enough that warning labels mentioning the possible side effects of "violence and suicide" should be put on the bottle to make consumers more aware of the rapidly mounting evidence that Prozac may chemically induce this reaction. Ten professionals sat on the FDA board. Although the FDA had felt that the financial interests held by these ten individuals would not sway their vote, so they had them sign a statement that they would not allow that to influence them. All five who admitted their interests at the beginning of the FDA hearing voted "against" the warning label.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 315

Fluoxetine and the other SSRIs may reduce the risk of suicide in depressed patients. However, there have been a few reports that fluoxetine may actually induce suicidal thoughts in selected patients, although this has not been confirmed. Public Citizen's Health Research Group petitioned the Food and Drug Administration in 1991 to require a box warning in the professional product labeling for fluoxetine warning doctors that a small minority of persons taking the drug have experienced intense, violent, suicidal thoughts, agitation, and impulsivity after starting treatment with the drug. You should not take this drug for mild depression or anxiety, or as a sleeping pill.
Worst Pills Best Pills by Sidney M Wolfe MD and Larry D Sasich PharmD MPH, page 235

Because of her suicidal and self destructive behavior her dosage of Prozac was increased, and along with that increase came an increase in suicidal ideation and self mutilation. Finally her doctor read Dr. Tiecher's report, immediately called her and told her he felt her problem was Prozac. She argued that she must "need" this antidepressant because of her odd behavior. Then as the evidence became clear to her, she asked, "You mean to tell me I have gone through this Hell because of an anti-depressant?!!" Rhonda Hala went off Prozac and returned to a normal mental and emotional state.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 216

I continued to check in with Joanne daily. The suicidal preoccupation subsided quickly and was completely gone within a week. Given what had happened, Joanne did not want to try another antidepressant. I wasn't feeling that bad before I started Prozac." Indeed, Joanne did fine without medication.
Prozac Backlash by Joseph Glenmullen MD, page 146

"I became obsessed with death, with my sickness. I became obsessed with the idea that I was a sick person who would have to be on antidepressants all my life. I became obsessed with dying. I thought dying was the only way out, and I had never contemplated suicide before that time. "
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 266

"Eli Lilly's staunch defense of Prozac"

Presumably Prozac's advocates were afraid any change in the prescribing guidelines for antidepressants, even a general warning, would have caused further public relations problems for the pharmaceutical industry. Public fear was already running high. Prozac was alleged to be associated with suicides, murders, murder-suicides, and even mass murder-suicides like Joseph Wesbecker's shooting spree at Standard Gravure. Numerous lawsuits had been filed in deaths associated with Prozac. Given how high profile the issue had already been, any suggestion that antidepressants could cause severe agitation that needed to be controlled with sedatives would only raise more questions. Pharmaceutical companies spend hundreds of millions of dollars developing and launching a drug like Prozac. By 1991, Prozac was already the number-one best-selling antidepressant, with sales near $1 billion a year. The stakes were indeed high. So the pharmaceutical industry and drug advocates decided to defend Prozac at all costs, despite the risks to individual and public safety.
Prozac Backlash by Joseph Glenmullen MD, page 162

Teicher and his colleagues went on to recommend that, "the practitioner be attentive to the possible emergence of suicidal ideation, even in those patients without a previous history of suicidal thoughts or actions. Patients who have previously been treated with other antidepressants or who develop intense fatigue, hypersomnia, or restlessness while taking fluoxetine [Prozac] may be at risk."
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 154

Healy himself has continued to publish on the subject of suicidality and violence associated with Prozac. He has published numerous articles and several books, including a recent one on the Prozac-type antidepressants. The antidepressant Era, published by Harvard University Press. In court declarations, Healy reports Lilly has been guilty of "bald mischaracterization" of his statements and work. Healy says Lilly's "refusal to mount or countenance further investigation" of Prozac's causing suicide and violence "must say something about their perceptions of what the likely outcome would be."
Prozac Backlash by Joseph Glenmullen MD, page 179

Suicidality was more frequent among patients receiving Prozac than among those receiving older, tricyclic antidepressants. "The relative risk of suicidality was 3.3. Interestingly, the proportion of patients with treatment-emergent suicidality on Prozac in this study was similar to that reported by Teicher" in his original article calling attention to the problem.
Prozac Backlash by Joseph Glenmullen MD, page 163

Although Prozac was reported to have fewer side effects than most antidepressants, and this was the basis for the aggressive marketing that has pushed Prozac to the top of the charts, the FDA lists approximately 575 side effects. Additionally, Lilly admitted to the FDA on April 20, 1990 that they did not include "suicidal thoughts" as an adverse event and therefore, did not look for that as a side effect in their clinical trials on Prozac.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 54

In the mid-1980s, the German food and drug administration notified Lilly that they were not going to approve Prozac "because of their concern with suicidality and agitation," said Dr. Lord. She continued, "They [the Germans] said that people became agitated before the antidepressant effects came on, and that increased the risk of suicide. They wrote a memo concerning damaging effects, and Lilly then went over there and looked at the data again and pulled out cases that they didn't think were suicide. How are they to know? The investigator [researcher] thought it was a suicide attempt. They said, well we don't think it is." Difficulties in other European countries were handled in a similar way.
Prozac Backlash by Joseph Glenmullen MD, page 169

"Some research studies and government organizations have ties to the pharmaceutical industry"

Britain's Dr. David Healy mentioned in a lecture at U of T that Prozac may trigger suicide in some patients. This has raised a real stir among scientists as Prozac's manufacturer, Eli Lilly, is an important private donor to a mental-health research institute affiliated with the university.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 280

One of the latest flaps in psychiatry circles that has spilled into the public press, deals with the safety of the SSRIs. Occasional suicides and violent behavior in children have led to calls by some to follow the lead of the British equivalent of our FDA in banning all SSRIs for children except Prozac, and early in February 2004 the FDA was scheduled to hold hearings on the issue. Days before the hearing, a group of researchers from the American College of Neuropsychopharmacology, headed by two prominent academic psychiatrists, released a preliminary analysis of their Task Force on SSRIs and Suicidal Behavior in Youth. It concluded that antidepressants did not increase the suicide risk in children, and that the benefits of SSRIs outweighed their risks.59 Their report was immediately criticized because nine of the ten panel members allegedly had "extensive ties to the pharmaceutical industry."60 Some critics labeled their report "junk science"; others were less restrained.61 At the hearing, FDA regulators testified that their analysis did suggest that in clinical trials the risk of suicide in children was increased over those taking placebos with some of the SSRIs.62 So far, the FDA has decided only to require a warning about possible suicide tendencies in descriptions of these drugs.
On The Take by Jerome P Kassirer M.D., page 127

Had the FDA decided to add a warning on suicide and violence to the label of antidepressants, this would have necessitated closer monitoring of patients, markedly reducing Prozac's unique appeal for primary-care clinicians.
Prozac Backlash by Joseph Glenmullen MD, page 167

All of these drugs by reducing 5HIAA serotonin levels should, therefore, produce any or all of the listed behaviors associated with low 5HIAA serotonin levels, ie: suicide, arson, violence, alcoholism, depression, insomnia, impulsive behavior, etc. These are many of the symptoms which patients are encouraged to take these drugs to alleviate. This has been a most incredible deception. Whatever the reason for patients, many physicians, the FDA, Congress, any of us, to have been kept in dark about the critical similarity of these antidepressant drugs to the psychedelic drugs and their potential to induce these behaviors is absolutely inexcusable.
PROZAC Panacea or Pandora by Ann Blake Tracy PhD, page 109