Fluoxetine misuse by snorting in a teenager: a case report

Abstract

Introduction Self-harm and substance use disorders (SUD) are leading causes of Years of Life Lost (YLLs) among young people aged 10-24 years as per the Global Burden of Disease (GBD) Study 2019. The co-occurrence of these conditions can complicate the clinical picture and often poses a challenge to child and adolescent mental health professionals. Moreover, substance use by adolescents, due to the probable physical, legal and psychiatric complications, has the potential to progress into full-blown SUD in adolescence or adulthood. Case Report We present the case of a 15-year-old female with a history of multiple serious suicidal attempts and drug use disorders who misused fluoxetine as part of maladaptive coping. Selective serotonin reuptake inhibitors (SSRIs) are not known to be commonly abused drugs, let alone sniffed or snorted. To the best of our knowledge, this is the first reported case of an adolescent snorting the drug fluoxetine (SSRI). Conclusion This case highlights three main aspects for child and adolescent mental health professionals. First, the importance of screening for recreational drugs misuse in general, including fluoxetine, in a comprehensive assessment of a young person with coexisting substance misuse issues or its history. Second, ‘comorbidity is the rule rather than the exception’ in adolescents with SUDs. Third, the possible benefit of quetiapine in managing emotional dysregulation in a high-risk adolescent with traits of an emerging borderline personality disorder.