The selective serotonergic agonist fluoxetine has demonstrated efficacy in the treatment of depression and has suggested efficacy in the treatment of alcoholism. However, no trials with any selective serotonin agonist have been reported in patients who display both major depression and alcoholism. In this study, 12 patients with DSM-III-R diagnoses of major depressive disorder and alcohol dependence were treated openly with fluoxetine for 8 weeks, with doses ranging from 20 mg to 40 mg p.o. qAM. All 12 patients reported prominent suicidal ideation upon admission to our hospital; 6 had made serious suicide attempts shortly before admission. Statistically significant improvements were noted on measures of depression and postdischarge alcohol consumption. No paradoxical increases in suicidality were noted. These findings suggest that fluoxetine has potential for treating the depressive symptoms and the excessive alcohol intake of depressed alcoholics.