Fluoxetine
Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant
Fluoxetine is one of the most widely prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants in the world. It is used to treat major depressive disorder, obsessive-compulsive disorder (OCD), and bulimia nervosa in adults, as well as moderate to severe depression in children and adolescents aged 8 years and older (in combination with psychological therapy). Fluoxetine has a uniquely long half-life among SSRIs, which provides a natural taper effect and a lower risk of discontinuation symptoms. Listed on the WHO Model List of Essential Medicines, fluoxetine has been extensively studied in clinical trials for over three decades.
Quick Facts: Fluoxetine
Key Takeaways
- Fluoxetine treats depression, OCD, and bulimia: It is one of the most extensively studied and prescribed SSRI antidepressants worldwide, listed on the WHO Essential Medicines List.
- Allow 2-4 weeks for effects: Antidepressants take time to work. Your doctor will review and adjust your dose after 3-4 weeks of treatment.
- Uniquely long half-life: Fluoxetine and its active metabolite norfluoxetine remain active for days to weeks, which reduces the risk of discontinuation symptoms compared to other SSRIs.
- Never combine with MAO inhibitors: Wait at least 2 weeks after stopping an MAO inhibitor before starting fluoxetine, and at least 5 weeks after stopping fluoxetine before starting an MAO inhibitor.
- Monitor for suicidal thoughts in young people: Patients under 25 years should be closely monitored for worsening depression and suicidal ideation, especially during the first weeks of treatment.
What Is Fluoxetine and What Is It Used For?
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, obsessive-compulsive disorder (OCD), and bulimia nervosa. It works by increasing the level of serotonin in the brain, which helps improve mood, reduce anxiety, and restore emotional balance.
Fluoxetine belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). These medications work by blocking the reabsorption (reuptake) of the neurotransmitter serotonin in the brain, thereby increasing serotonin availability in the synaptic cleft. Serotonin is a chemical messenger that plays a key role in regulating mood, sleep, appetite, and anxiety. People with depression, OCD, or bulimia often have lower levels of serotonin activity, and fluoxetine helps to correct this imbalance.
It is important to understand that fluoxetine does not provide immediate relief. The therapeutic effect typically develops over 2 to 4 weeks of consistent use, with full benefit often requiring 6 to 8 weeks. This is because the brain needs time to adapt to the increased serotonin levels and restore normal neural signaling pathways. Patients should not discontinue treatment if they do not feel improvement immediately.
Approved Uses in Adults
- Major depressive disorder (MDD): Fluoxetine is a first-line treatment for clinical depression. The recommended starting dose is 20 mg daily, which can be increased up to 60 mg daily if needed. Treatment should continue for at least 6 months to reduce the risk of relapse.
- Obsessive-compulsive disorder (OCD): Fluoxetine is effective for reducing the frequency and intensity of obsessive thoughts and compulsive behaviors. Doses typically range from 20 to 60 mg daily, with clinical review after 10 weeks to assess response.
- Bulimia nervosa: Fluoxetine is the only SSRI approved for the treatment of bulimia nervosa, where it is used in combination with psychotherapy to reduce binge-eating and purging behaviors. The recommended dose for bulimia is 60 mg daily.
Use in Children and Adolescents (Aged 8-18 Years)
Fluoxetine is the preferred SSRI for treating moderate to severe major depressive disorder in children and adolescents aged 8 years and older, but only when depression has not responded to 4 to 6 sessions of psychological therapy. It must always be prescribed in combination with ongoing psychological treatment. The starting dose is typically 10 mg daily, which may be increased to 20 mg daily after 1 to 2 weeks. Children with lower body weight may require lower doses.
Fluoxetine should not be used for the treatment of depression in children younger than 8 years. For OCD and bulimia, fluoxetine is only approved for use in adults. Limited long-term safety data exists regarding the effects of fluoxetine on growth, puberty, and cognitive development in pediatric populations.
How Does Fluoxetine Work?
Everyone has a substance called serotonin in the brain. Serotonin is a neurotransmitter — a chemical that carries signals between nerve cells. People with depression, OCD, or bulimia tend to have reduced serotonin signaling. While the exact mechanism is not fully understood, fluoxetine and other SSRIs appear to help by increasing serotonin levels in the brain, which in turn helps regulate mood, anxiety, and behavior.
What makes fluoxetine unique among SSRIs is its exceptionally long half-life. The parent compound has a half-life of 1 to 3 days, while its active metabolite norfluoxetine has a half-life of 4 to 16 days. This means the drug stays in the body significantly longer than other SSRIs such as citalopram or escitalopram, which has important clinical implications: it provides a natural taper effect when stopping treatment and results in a lower incidence of discontinuation symptoms.
What Should You Know Before Taking Fluoxetine?
Before taking fluoxetine, inform your doctor about all medical conditions, especially heart disease, epilepsy, diabetes, liver problems, glaucoma, or any history of mania or bipolar disorder. Do not take fluoxetine if you are currently using MAO inhibitors or metoprolol for heart failure.
Contraindications
Fluoxetine must not be taken in the following situations:
- Allergy to fluoxetine or any other ingredient in the formulation. Stop treatment immediately and seek medical attention if you develop a rash, itching, swollen face or lips, or difficulty breathing.
- Concurrent use of irreversible, non-selective MAO inhibitors (e.g., iproniazid, phenelzine, tranylcypromine), as serious and potentially fatal reactions can occur including serotonin syndrome. A minimum of 2 weeks must elapse after stopping an MAO inhibitor before starting fluoxetine, and at least 5 weeks must pass after stopping fluoxetine before starting an MAO inhibitor.
- Concurrent use of metoprolol for heart failure, due to an increased risk of excessive bradycardia (abnormally slow heart rate).
Warnings and Precautions
Talk to your doctor or pharmacist before taking fluoxetine if you have any of the following conditions or circumstances:
- Any heart disease or history of cardiac arrhythmias
- Current or previous episodes of mania or bipolar disorder
- History of bleeding disorders, or if you are pregnant
- Use of anticoagulants (blood thinners) or NSAIDs
- Epilepsy or history of seizures
- Diabetes (your doctor may need to adjust insulin or diabetes medication doses)
- Liver impairment (a reduced dose or alternate-day dosing may be necessary)
- Low resting heart rate or electrolyte imbalances
- Glaucoma (increased intraocular pressure)
- Concurrent treatment with tamoxifen for breast cancer
- Concurrent use of diuretics, especially in elderly patients
If you suddenly develop unexplained fever, rapid breathing or heart rate, sweating, muscle stiffness or twitching, confusion, or extreme agitation while taking fluoxetine, you may have serotonin syndrome. This is a rare but potentially life-threatening condition. Contact your doctor or seek emergency care immediately.
Suicidal Thoughts and Worsening Depression
Patients with depression may sometimes have thoughts of self-harm or suicide. These thoughts may increase when first starting antidepressant treatment, as the medication typically takes at least 2 weeks to produce a therapeutic effect. The risk is particularly important in the following groups:
- Patients who have previously had thoughts of self-harm or suicide
- Young adults under 25 years of age — clinical studies have shown an increased risk of suicidal thinking in this age group during early treatment with antidepressants
If you experience thoughts of self-harm or suicide at any point during treatment, contact your doctor immediately or seek emergency care. It can be helpful to tell a family member or close friend about your condition and ask them to alert you or your doctor if they notice changes in your mood or behavior.
Children and Adolescents (8-18 Years)
The risk of suicidal behavior (attempts and thoughts), hostility (including aggression, oppositional behavior, and anger) is greater in patients under 18 years of age taking SSRI antidepressants. Fluoxetine should only be prescribed for children and adolescents aged 8 to 18 for moderate to severe depression, and always in combination with psychological therapy. Long-term safety data are limited with respect to effects on growth, pubertal development, and cognitive, emotional, and behavioral development.
Pregnancy and Breastfeeding
Pregnancy: If you are pregnant, planning to become pregnant, or suspect you may be pregnant, discuss this with your doctor before taking fluoxetine. Studies have shown a slightly increased risk of cardiac birth defects in infants whose mothers took fluoxetine during the first trimester (approximately 2 per 100 births, compared to the general rate of approximately 1 per 100). Use during late pregnancy may increase the risk of persistent pulmonary hypertension of the newborn (PPHN) and neonatal withdrawal symptoms such as irritability, tremor, feeding difficulties, and disturbed sleep. Your doctor will help you weigh the benefits of treating depression against the potential risks to your baby. There may also be an increased risk of heavy vaginal bleeding shortly after delivery (postpartum hemorrhage).
Breastfeeding: Fluoxetine passes into breast milk and may cause side effects in nursing infants. Breastfeeding should only continue if strictly necessary, and your doctor may prescribe a lower dose.
Fertility: Animal studies have shown that fluoxetine may reduce sperm quality. While reduced fertility has not been demonstrated in humans, patients concerned about fertility should discuss this with their doctor.
Driving and Operating Machinery
Fluoxetine and other psychotropic medications can impair judgment and coordination. Do not drive or operate machinery until you know how fluoxetine affects you. Drowsiness, dizziness, and impaired concentration are possible side effects that may affect your ability to perform these activities safely.
Alcohol
You should avoid alcohol while taking fluoxetine. Both substances affect the central nervous system, and their combination can increase drowsiness, impair judgment, and worsen symptoms of depression. Alcohol may also reduce the effectiveness of fluoxetine treatment.
How Does Fluoxetine Interact with Other Drugs?
Fluoxetine has significant drug interactions, particularly with MAO inhibitors (which must never be combined), metoprolol for heart failure, tamoxifen, anticoagulants such as warfarin, and medications that affect the QT interval. Always tell your doctor about all medications you are taking, including over-the-counter drugs and herbal supplements.
Fluoxetine is primarily metabolized by the liver enzyme CYP2D6, and it is a potent inhibitor of this enzyme. This means that fluoxetine can significantly increase the blood levels of other drugs that are metabolized by CYP2D6, potentially leading to increased side effects or toxicity. Additionally, fluoxetine's long half-life means that these interactions can persist for several weeks after discontinuation.
Major Interactions (Avoid Combination)
| Drug / Class | Risk | Action Required |
|---|---|---|
| Irreversible MAO inhibitors (iproniazid, phenelzine, tranylcypromine) | Fatal serotonin syndrome | Contraindicated. Wait 2 weeks after stopping MAO inhibitor; 5 weeks after stopping fluoxetine |
| Metoprolol (for heart failure) | Excessive bradycardia | Contraindicated combination |
| Linezolid (antibiotic) / Methylene blue | Serotonin syndrome | Avoid combination; use alternatives if possible |
| Pimozide / Mequitazine | QT prolongation, cardiac arrhythmia | Avoid combination |
Moderate Interactions (Use with Caution)
| Drug / Class | Risk | Action Required |
|---|---|---|
| Tamoxifen | Reduced efficacy of tamoxifen (fluoxetine inhibits CYP2D6, blocking conversion to active metabolite) | Consider alternative antidepressant |
| Warfarin and other anticoagulants | Increased bleeding risk | Monitor INR closely; dose adjustment may be needed |
| NSAIDs (ibuprofen, diclofenac) / Aspirin | Increased risk of gastrointestinal bleeding | Use with caution; consider gastroprotection |
| Lithium / Triptans / Tramadol | Mild serotonin syndrome | Closer clinical monitoring required |
| Phenytoin | Increased phenytoin blood levels | Introduce phenytoin cautiously; monitor blood levels regularly |
| Tricyclic antidepressants (imipramin, amitriptyline) | Increased TCA blood levels; seizure risk | Dose reduction of TCA may be required |
| Flecainide, propafenone, nebivolol | Increased blood levels (CYP2D6 substrates) | Dose reduction may be needed |
| St. John's Wort (Hypericum perforatum) | Serotonin syndrome risk | Avoid concurrent use |
Minor Interactions
- Cyproheptadine (antihistamine): May reduce the effectiveness of fluoxetine
- Diuretics: Increased risk of low sodium levels (hyponatremia), especially in elderly patients
- Carbamazepine / Oxcarbazepine: May lower sodium levels when combined with fluoxetine
- Desmopressin: Increased risk of hyponatremia
Due to fluoxetine's long half-life and potent CYP2D6 inhibition, drug interactions can persist for up to 5 weeks after stopping fluoxetine. Always tell your doctor and pharmacist about all prescription medications, over-the-counter drugs, and herbal supplements you are taking or have recently taken.
What Is the Correct Dosage of Fluoxetine?
The standard adult dose for depression is 20 mg once daily, which may be increased up to 60 mg daily. For bulimia, the recommended dose is 60 mg daily. For OCD, the dose ranges from 20 to 60 mg daily. Always take fluoxetine exactly as prescribed by your doctor.
Fluoxetine can be taken with or without food. Capsules should be swallowed with a glass of water. The oral solution can be measured using the provided dosing syringe. Take fluoxetine at the same time each day to help you remember. The dose should always be increased gradually to ensure you receive the lowest effective dose.
Adults
Depression
Starting dose: 20 mg per day. Your doctor will review and adjust the dose after 3-4 weeks. If needed, the dose can be gradually increased up to a maximum of 60 mg per day. Treatment should continue for at least 6 months to prevent relapse.
Obsessive-Compulsive Disorder (OCD)
Starting dose: 20 mg per day. Your doctor will review after 2 weeks and may increase the dose gradually up to a maximum of 60 mg per day. If no improvement is seen within 10 weeks, treatment should be reconsidered.
Bulimia Nervosa
Recommended dose: 60 mg per day, used in combination with psychotherapy to reduce binge-eating and purging behavior.
Children and Adolescents (8-18 Years)
Moderate to Severe Depression
Starting dose: 10 mg per day. After 1-2 weeks, the dose may be increased to 20 mg per day. Treatment must be initiated and supervised by a specialist and must always be combined with psychological therapy. Children with low body weight may need lower doses. If good results are achieved, the need for continued treatment should be reassessed after 6 months. If no improvement is seen within 9 weeks, treatment should be reconsidered.
Elderly Patients
Dose increases should be made cautiously in elderly patients. The daily dose should generally not exceed 40 mg. The maximum permitted dose is 60 mg per day.
Patients with Liver Impairment
If you have liver disease or are taking medications that can affect fluoxetine metabolism, your doctor may prescribe a lower dose or recommend taking fluoxetine every other day.
Missed Dose
If you miss a dose of fluoxetine, do not worry. Take your next dose at the usual time the following day. Do not take a double dose to make up for a missed one. Because fluoxetine has a very long half-life, missing a single dose is unlikely to cause significant problems.
Overdose
If you or someone else has taken too much fluoxetine, contact your doctor, hospital, or poison control center immediately. Bring the medication packaging if possible. Symptoms of overdose may include: nausea, vomiting, seizures, heart rhythm problems (irregular heartbeat, cardiac arrest), respiratory problems, and altered mental state ranging from extreme agitation to loss of consciousness.
What Are the Side Effects of Fluoxetine?
Like all medications, fluoxetine can cause side effects, though not everyone experiences them. The most common side effects (affecting more than 1 in 10 people) include insomnia, headache, diarrhea, nausea, and fatigue. Most side effects are mild and tend to improve as your body adjusts to the medication.
Side effects are most likely to occur during the first few weeks of treatment and often diminish over time. If you experience severe or persistent side effects, contact your doctor. Do not stop taking fluoxetine without medical advice, as abrupt discontinuation may cause withdrawal symptoms.
Very Common
- Insomnia (difficulty sleeping)
- Headache
- Diarrhea
- Nausea
- Fatigue
Common
- Decreased appetite and weight loss
- Nervousness, anxiety, restlessness
- Difficulty concentrating
- Decreased libido and sexual problems (including erectile dysfunction, difficulty reaching orgasm)
- Unusual dreams, drowsiness
- Dizziness, taste changes
- Blurred vision
- Palpitations (feeling of fast or irregular heartbeat)
- Hot flashes, yawning
- Indigestion, vomiting, dry mouth
- Skin rash, hives, itching, excessive sweating
- Joint pain, frequent urination
- Unexpected vaginal bleeding
- Feeling shaky or having chills
Uncommon
- Feeling detached from oneself (depersonalization)
- Abnormal elevated mood (euphoria)
- Sexual dysfunction (orgasm problems, which may occasionally persist after stopping treatment)
- Suicidal thoughts or thoughts of self-harm
- Teeth grinding (bruxism)
- Muscle twitching, involuntary movements, balance problems
- Impaired memory, dilated pupils
- Tinnitus (ringing in the ears)
- Low blood pressure, shortness of breath, nosebleeds
- Difficulty swallowing, hair loss
- Increased bruising, cold sweats
- Difficulty urinating, abnormal liver test values
Rare
- Low sodium levels in the blood (hyponatremia)
- Decreased platelet count (increased bleeding risk)
- Decreased white blood cell count
- Violent behavior, hallucinations, confusion
- Panic attacks, aggressiveness, stuttering
- Seizures (convulsions)
- Vasculitis (inflammation of blood vessels)
- Rapid swelling of face, mouth, or throat (angioedema)
- Hepatitis (liver inflammation)
- Sensitivity to sunlight
- Lung problems, muscle pain
- Milk discharge from breasts (galactorrhea)
Frequency Not Known
- Heavy vaginal bleeding shortly after delivery (postpartum hemorrhage)
- Bone fractures (increased risk seen with long-term use of this class of medication)
- Prolonged and painful erection (priapism)
- Serotonin syndrome (fever, rapid breathing/heartbeat, sweating, muscle stiffness, confusion)
Sexual Dysfunction
SSRIs including fluoxetine can cause symptoms of sexual dysfunction such as decreased libido, erectile dysfunction, and difficulty reaching orgasm. In some cases, these symptoms have persisted after discontinuing treatment. If you experience sexual side effects, discuss them with your doctor, who may consider adjusting your dose or switching to a different medication.
Side Effects in Children and Adolescents (8-18 Years)
In addition to the side effects listed above, fluoxetine may reduce growth rate and potentially delay puberty in children and adolescents. Suicidal behavior (attempts and thoughts), hostility (aggression, oppositional behavior), mania, and nosebleeds have also been reported as common side effects in this age group.
How Should You Stop Taking Fluoxetine?
Do not stop taking fluoxetine without consulting your doctor, even if you feel better. Your doctor will help you taper the dose gradually over 1 to 2 weeks to minimize the risk of discontinuation symptoms. Fluoxetine's long half-life makes it less likely than other SSRIs to cause withdrawal effects.
It is important to continue taking fluoxetine as prescribed and not to stop abruptly. Even if you feel well, stopping medication too early can increase the risk of relapse. When you and your doctor decide to discontinue treatment, the dose will typically be reduced gradually over 1 to 2 weeks.
Common Discontinuation Symptoms
The following symptoms may occur when reducing or stopping fluoxetine, though they are generally milder than with other SSRIs due to fluoxetine's long half-life:
- Dizziness and tingling sensations
- Sleep disturbances (vivid dreams, nightmares, insomnia)
- Feeling of restlessness or agitation
- Unusual tiredness or weakness
- Anxiety, nausea, vomiting, trembling
- Headache
Most people who stop fluoxetine find that these symptoms are mild and resolve within a few weeks. If discontinuation symptoms are troublesome, contact your doctor, who may recommend a slower taper.
How Should You Store Fluoxetine?
Store fluoxetine at room temperature, out of the sight and reach of children. Do not use after the expiry date printed on the packaging. No special storage conditions are required.
- Keep out of the sight and reach of children
- Do not use after the expiry date stated on the packaging (EXP). The expiry date refers to the last day of that month.
- No special storage conditions are required
- Do not dispose of medications via wastewater or household waste. Ask your pharmacist how to properly dispose of medications that are no longer needed. These measures help protect the environment.
What Does Fluoxetine Contain?
The active ingredient is fluoxetine (as fluoxetine hydrochloride). Each hard capsule contains 20 mg of fluoxetine. The oral solution contains 4 mg/ml of fluoxetine.
Active Ingredient
Fluoxetine hydrochloride, equivalent to 20 mg fluoxetine per capsule or 4 mg fluoxetine per ml of oral solution.
Inactive Ingredients (Excipients)
The inactive ingredients may vary slightly between different brands and formulations. Common excipients in fluoxetine capsules include microcrystalline cellulose, croscarmellose sodium, magnesium stearate, and colloidal anhydrous silica. The capsule shell typically contains gelatin, titanium dioxide, and various coloring agents. The oral solution may contain sorbitol, glycerol, sucrose, citric acid, and flavoring agents.
Fluoxetine capsules contain less than 1 mmol (23 mg) sodium per unit, meaning they are essentially sodium-free. If you are on a sodium-restricted diet, this medicine will not significantly contribute to your daily sodium intake.
Available Formulations
- Hard capsules: 20 mg fluoxetine
- Oral solution: 4 mg/ml fluoxetine
Frequently Asked Questions About Fluoxetine
Fluoxetine typically takes 2 to 4 weeks before you begin to notice an improvement in symptoms, although some people may feel early effects sooner. Full therapeutic benefit is usually achieved after 6 to 8 weeks of consistent treatment. It is important not to stop taking fluoxetine early, even if you feel it is not working immediately. Your doctor will review your response after 3 to 4 weeks and adjust the dose if necessary.
Alcohol should be avoided while taking fluoxetine. Both fluoxetine and alcohol affect the central nervous system, and combining them can increase drowsiness, impair judgment, and worsen depression or anxiety symptoms. Alcohol may also reduce the effectiveness of fluoxetine and increase the risk of side effects such as dizziness and gastrointestinal problems.
If you miss a dose, take your next dose at the usual time the following day. Do not take a double dose to compensate. Because fluoxetine has a very long half-life (1-3 days for the parent drug and 4-16 days for its active metabolite norfluoxetine), missing a single dose is unlikely to cause significant withdrawal symptoms or noticeably affect your treatment.
Fluoxetine use during pregnancy requires careful evaluation by your doctor. Studies suggest a slightly increased risk of cardiac birth defects when taken in the first trimester (from about 1% to 2% of births). Late pregnancy use may increase the risk of neonatal adaptation symptoms. However, untreated depression during pregnancy also carries significant risks for both mother and baby. Your doctor will help you weigh the benefits against the risks and may suggest gradual discontinuation or continued treatment depending on your individual circumstances. Never stop fluoxetine abruptly without medical guidance.
Never stop fluoxetine suddenly without consulting your doctor. Although fluoxetine has a longer half-life than other SSRIs — which naturally reduces the risk of discontinuation symptoms — your doctor will typically recommend tapering the dose gradually over 1 to 2 weeks. If long-term use or high doses were involved, a longer tapering period may be advised. Possible withdrawal symptoms include dizziness, tingling, sleep disturbances, anxiety, nausea, and headache, but these are generally mild and resolve within a few weeks.
Fluoxetine is generally considered one of the more weight-neutral SSRIs. In the short term, many patients actually experience slight weight loss due to reduced appetite, which is a common side effect. However, long-term use (over several months to years) may lead to modest weight gain in some individuals. Weight effects vary considerably from person to person. If you are concerned about weight changes, discuss this with your doctor, who can suggest dietary and lifestyle modifications or consider dose adjustments.
References and Sources
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: WHO; 2023. Available at: www.who.int/publications
- European Medicines Agency (EMA). Fluoxetine – Summary of Product Characteristics (SmPC). Amsterdam: EMA. Available at: www.ema.europa.eu
- National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222], 2022. London: NICE. Available at: www.nice.org.uk/guidance/ng222
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7
- British National Formulary (BNF). Fluoxetine. London: BMJ Group and Pharmaceutical Press. Available at: bnf.nice.org.uk
- U.S. Food and Drug Administration (FDA). Prozac (fluoxetine hydrochloride) Prescribing Information. Silver Spring: FDA. Available at: www.accessdata.fda.gov
- Soomro GM, Altman DG, Rajagopal S, Oakley Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev. 2008;(1):CD001765. doi: 10.1002/14651858.CD001765.pub3
- Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021;5(5):CD013674. doi: 10.1002/14651858.CD013674.pub2
Editorial Team and Medical Review
This article has been written and medically reviewed by the iMedic Medical Editorial Team, comprising board-certified specialists in psychiatry, clinical pharmacology, and internal medicine.
Medical Content
Written by licensed physicians with specialization in clinical pharmacology and psychiatry
Medical Review
Reviewed by the iMedic Medical Review Board according to EMA, FDA, WHO, and NICE guidelines
Evidence Standard
Level 1A evidence based on systematic reviews, meta-analyses, and randomized controlled trials
Editorial Independence
No pharmaceutical company sponsorship. Independent medical editorial content following GRADE framework
Last medically reviewed: | Next review due: January 2027