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A major depressive episode may be the initial presentation of Bipolar DisorderIt is generally believedthough not established in controlled trialsthat treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for Bipolar DisorderWhether any of the symptoms described for clinical worsening and suicide risk represent such a conversion is unknownHoweverprior to initiating treatment with an antidepressantpatients with depressive symptoms should be adequately screened to determine if they are at risk for Bipolar Disordersuch screening should include a detailed psychiatric historyincluding a family history of suicideBipolar Disorderand depressionIt should be noted that SARAFEM is not indicated for the treatment of depressive episodes associated with Bipolar I Disorder.

Many drugs besides fluoxetine may affect the heart rhythmQT prolongationincluding pimozide and thioridazineamong others.

Concomitant use of SARAFEM in patients taking thioridazine is contraindicatedThioridazine isoniazid. should not be administered with fluoxetine or within a minimum of 5 weeks after fluoxetine has been discontinuedsee CONTRAINDICATIONS

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