Letter to the Editor
Sir: While depression, dysthymia, and panic disorder can
often be effectively treated with the selective serotonin reuptake
inhibitors (SSRIs), patients are sometimes left with treatmentemergent
sedation or fatigue that can itself be quite disabling.
Although Keck and McElroy3 postulated that, for fluoxetine,
this may be related to an elevated norfluoxetine/fluoxetine ratio,
personal experience has shown this fatigue to be present in
some cases where the tested ratio was less than one.
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