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The Controversies Surrounding Fluoxetine, Prozac’s Active Ingredient

Alternative to Meds Editorial Team Medically Reviewed by Dr John Motl MD Table of Contents: Video: Prozac Withdrawal, Fluoxetine Tapering Empowerment Through Education about Medication How Do Issues With Serotonin

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Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

Prozac, despite its controversial history, has become one of the most prescribed medications in the world. Prozac’s approved uses include major depressive disorder, OCD, bulimia, and panic disorders. Prozac (fluoxetine) is also FDA-approved for bipolar conditions and for what is termed “treatment resistive depression” if prescribed along with olanzapine, an antipsychotic medication. Treatment resistive depression means 2 or more other antidepressants have previously been tried and found unsuccessful.1

Due Diligence is Critical


The safety and efficacy of Prozac has come under scrutiny since it was released. There are some who experience positive effects, at least temporarily, and some who experience negative effects. The controversy rests mainly with safety and efficacy claims, and some researchers pointing to the question of placebo effects vs direct drug effects. Learn more about what is known, exactly, about the active ingredient in Prozac (fluoxetine hydrochloride) and some of the reasons it has become a controversial treatment choice.

truth about Fluoxetine
Alternative to Meds Center has expertise acquired over 18 years of helping clients through tapering and withdrawal of antidepressants. Independently published evidence clearly demonstrates that more than three-quarters of ATMC clients tapering off fluoxetine or other drugs do better by tapering off them and replacing prescription drugs with a holistic lifestyle and other non-toxic choices to authentically and truly improve their health.

Empowerment Through Learning about Medication

When faced with a confusing or concerning medical issue, we often rely upon the knowledge and expertise of medical professionals. When it comes to treatment options, we trust that they are making choices in our best interests. However, personal due diligence is also important when it comes to medication. In the rush toward getting relief, sometimes one may fail to explore any alternative solutions. take the time to learn about medicationsAs it turns out, there’s more to learn about many of the drugs on the market today — that even prescribers may not be aware of.

While fluoxetine is classed as an antidepressant, it is more specifically an SSRI, or selective serotonin reuptake inhibitor. The aim of SSRIs is to help increase the level of serotonin active in the brain. Serotonin is a natural chemical — a neurotransmitter — that is designed to buffer the impact of outside stimulation, and in this way, is thought to have a softening effect on mood. Serotonin is associated with feelings of relaxation and ease. Serotonin also regulates thousands of other functions of the body, including digestion, sleep, blood sugar levels, metabolism, growth, gastrointestinal motility, and a very wide range of other vital functions.6

It’s important to know that no drug can create serotonin. Serotonin (and many other natural chemicals) are produced mainly in the gut, and distributed along the body’s highly refined system of nerve channels. Drugs like fluoxetine can manipulate the transmission of serotonin, but cannot create more.7

In addition, the idea of specifically targeting serotonin in the treatment of depression has been under robust debate for some time. Recent research has begun to question whether there is any relationship between low serotonin and depression. And certainly, the mechanics of how SSRIs are thought to work may be more nuanced than was previously believed.2-4

How Do Issues With Serotonin Production Affect the Human Body?

Interest in serotonin seems to have centered on two categories: issues that arise when there’s a scarcity of serotonin and issues that occur when there’s too much serotonin. The former is the narrative often cited as a contributor to anxiety and depression, although the evidence for that has become a matter of debate. Prozac was originally marketed to correct a “serotonin imbalance.”

The theory was that Prozac could correct an imbalance of serotonin and relieve feelings of unhappiness, hopelessness, and even suicidal ideation. This is an area of debate, as more researchers such as Moncrieff, Horowitz, and others, have begun to question this narrative that has been in play for decades.2-4

Ironically, fluoxetine carries a black box warning for suicide.12

You can find more on the marketing of fluoxetine further below.

What is Serotonin Syndrome?

serotonin issuesElevated levels of serotonin can be problematic and even life-threatening. Instances where there is too much serotonin activated may lead to serotonin syndrome. This is a state of drug-induced toxicity where medication has caused too much serotonin to become activated.

Some cases of SS occur after a single dose of a serotonergic medication, and other cases occur where 2 or more serotonergic agents have been taken concurrently. For example, St. John’s Wort should not be taken concurrently with an SSRI medication, due to their combined effects. Multiple serotonergic drugs taken simultaneously, such as taking Prozac and Celexa together, should be avoided.

The condition is potentially life threatening and needs immediate treatment to save the patient’s life. It’s one of the rare scenarios where abrupt cessation of the drug is necessary. Since serotonin regulates so many systems in the body, many negative presentations can arise with serotonin toxicity. Some of the clinical abnormalities that are signs and symptoms of serotonin syndrome are listed below. Doctors should not only be aware of these symptoms, but should inform their patients before prescribing SSRIs like Prozac, and especially in cases of combining prescriptions drugs and in cases of polypharmacy (5 or more prescription drugs being taken). 5,15,17

Signs and symptoms of serotonin syndrome:
  • Elevated heart rate (tachycardia)
  • Unstable heart rate
  • Seizures
  • Increased or unstable blood pressure
  • Hyperthermia (overheating due to loss of internal regulation)
  • Profuse sweating (diaphoresis)
  • Confusion
  • Agitation
  • Dilated pupils
  • Akathisia
  • Tremors (rhythmic involuntary muscle movements)
  • Sudden, brief, involuntary jerky muscle spasms (myoclonus)
  • Increased or overactive reflex responses (hyperreflexia)
  • Coma, unresponsiveness
  • Muscle rigidity
  • Flushed skin
  • Sweating
  • Increased bowel activity

If these sign present, one should seek immediate medical attention. Call 911 or have someone arrange transport to the nearest ER unit without delay. Early recognition and treatment, such as giving the patient a serotonin agonist before complete shutdown occurs, are vital for the patient to survive.5,15

What Does an SSRI Do?

SSRIs are compounds that specifically target serotonin molecules. Serotonin is a natural neurotransmitter, a messenger molecule. The messenger’s job is to carry signals throughout the central nervous system, telling other cells what to do, or what not to do. SSRIs block this pathway, so the messenger molecules become suspended, instead of continuing to travel along their normal relay line, on to the next receptor in the the nerve pathway. Chronic use of SSRIs can trigger what is called downregulation. Downregulation of serotonin receptors occurs over time, which means they become less responsive, and less in number.10

You might think of the central nervous system as a giant switchboard consisting of lines, receivers, transmitters, and of course, messages. Neurotransmitters such as serotonin have the task of sending communication between various parts of your body, transmitting signals between neurons to other cells. After delivering the message, the serotonin molecules are normally reabsorbed into the vesicles (storage sacs) of the nerve cells in your body. There they remain protected, ready to be used again, and again, as the need arises.

However, an SSRI disables this process. The serotonin molecules can’t be stored in the vesicles, and they remain suspended, and now subject to deterioration via nearby enzymes. So over time, these serotonin molecules can deteriorate and become waste material. Whether or not one had a serious serotonin deficiency before antidepressant use, after SSRI use this is certainly a possibility. Animal studies have shown this to be true.8,9

The History of Fluoxetine

ground-up rat brains used in development of fluoxetine prozacWe have a lot of rats to thank for the development of fluoxetine, according to the American-based Institute of Science History.10 Chemists employed by Eli Lily borrowed a method introduced to them by a John’s Hopkins chemist named Solomon Snyder. Snyder showed them how he first drugged rats with chlorpromazine, an antipsychotic, ground up their brains, and took extracts of those rat brains. Snyder found that these rat-brain-extracts responded to other experiments just the same way live nerve endings responded.

So, many chemists at Eli Lily experimented with drugging rats with other chemicals, grinding up their brains, and using the rat-brain-extracts as Snyder had showed them. They found one compound in particular had the effect of stopping serotonin reuptake in ground-up-rat-brains.

That was the birth of fluoxetine.10

The other part of the story was the narrative about natural transmitter deficiencies leading to depression, and the idea that Prozac and other SSRIs could correct such a deficiency. Since 1987, this theory has come under scrutiny.2-4

The Marketing of Prozac

The efforts dedicated to marketing Prozac cannot be understated. Prior to Prozac’s release, antidepressants in general and ECT as another treatment for depression, had become unpopular mainly due to their dangerous side effects. Prozac was touted as the super-drug that was going to change all that.

the marketing of prozacEverything from the promotional language surrounding its release, to the materials given to medical professionals, to the very name of the drug, was intentionally chosen to maximize its positive reception. The name Prozac was chosen to appear both professional and snappy, remaining in line with the overall messaging of fluoxetine serving as a “one-pill-fits-all” solution.

The main angle of the promotional materials advertising Prozac used the guise of teaching vital information about depression to consumers, cautioning the public about the dangers of remaining depressed  — while extolling the benefits of Prozac. This came at a time where previous negative experiences with the side effects of antidepressants weighed heavily upon the populace, making the promise of an exciting, effective new drug even more enticing. Prozac became a trendy choice, recommended by celebrities, best-selling books like “Prozac Nation,” and “Listening to Prozac,” and the name “Prozac” saturated all media.

In addition to targeting those with depression, Prozac was promoted towards increasingly larger groups of people to continue capitalizing on the drug’s popularity. Not only was it recommended to those with diagnosed depression and anxiety, but it was also offered as a potential cure for those who simply struggled with shyness or those looking for an easy way to feel happier. Over time Prozac was even marketed towards children. In fact, the FDA approved it for children age 7 with OCD, and age 8 for children diagnosed with MDD (major depressive disorder.)11,12

Controversy Over Fluoxetine

controversy over fluoxetineThe biggest challenge fluoxetine faces is the lack of evidence on its effectiveness. A marketing formula was heavily promoted: low serotonin equals depression, so a drug that helps you increase serotonin should cure it. Even a child could understand the concept. What could possibly be missing in this equation? In fact, the conversation about the hype surrounding Prozac is often missing facts about side effects, efficacy, managing Prozac withdrawal safely, as well as nuance and individual contexts of the persons who are prescribed such a drug. 2,3,6,9,20-22

It’s true that there is a relationship between neurochemicals and the functions of the body. However, like the other hormones and neurotransmitters in your system, serotonin does not work in isolation. There are many distinct factors that could potentially have an impact on the various facets of your health, including depression. Under certain circumstances, our emotional state and stress levels can actually affect our brain chemistry. This begs important questions. Are reduced serotonin levels more of a symptom of depression than the source? Is there a causative and direct relationship at all?

New research begins to peel away some of the blurred lines. There has been no actual evidence that low serotonin is the main cause of depression, or any of the other conditions Prozac is used to treat like obsessive-compulsive disorders, eating disorders, and many others off-label. In fact, in 2003/4, JAMA released statements as did the National Health Service in the UK denouncing the use of Prozac and 6 other “newer” antidepressants in those under the age of 18. Lack of efficacy and harmful risks were the reasons for the ban. In 2021, Eli Lily revised their prescriber information to include 10 pages of warnings that were not in the original prescribing guidelines.13,14

So the light is beginning to shine.

Risks of Prozac

prozac fluoxetine increased serotonin levelsIn addition to questions about its value as an antidepressant, Prozac also presents some significant risks. First, common negative side effects include nausea, increased anxiety, trouble sleeping, and fatigue. Some patients also report significant side effects like agitation, akathisia, rage, hostility, and other extreme changes to their mood. Also reported are uncontrollable muscle spasms, tremors, decreased libido, and sexual dysfunction even after withdrawal from the drug. One of the most serious possible side effects is increased thoughts of suicide.

As mentioned above, there is also a heightened chance of developing serotonin syndrome while taking Prozac, or any of the SSRI medications. Serotonin syndrome occurs most frequently when a dose is changed, when a second serotonergic medication is added, in overdose, or when serotonergic medications are switched. Because SSRI drugs interfere with the natural serotonin uptake process, it’s possible for you to end up with too much serotonin being activated. Increased serotonin levels subject you to many negative symptoms, on top of Prozac’s side effects, and the initial condition that prompted your doctor to prescribe Prozac in the first place.

Finally, there is the matter of withdrawal. Prozac’s metabolite has a very long half-life, meaning it stays active in the body for between 4 and 16 days. Nonetheless, persons being withdrawn from Prozac are advised to do so gradually to avoid unnecessary discomfort. And prescribers are particularly cautioned not to prescribe other medications, especially those in the SSRI class, before complete blood plasma elimination, due to the risk of severe drug-drug interactions. Symptoms of withdrawal syndrome include digestive issues like nausea and vomiting, dizziness, flu-like symptoms, worsened depression, worsened sleep, and many others. Seek trusted help and; guidance for withdrawal from mental health drugs for the safest outcome.

Prozac, Zoloft, and Luvox, Other SSRIs

SSRIs do your due diligenceOften, the names of Prozac, Zoloft, Luvox, and other drugs are easily confused, as they are all classified as SSRI antidepressants. In fact, in everyday conversations surrounding medication meant to treat common mental health issues like anxiety and depression, these three are used so interchangeably it might make a person wonder, what is Luvox (fluvoxamine)? Is Luvox the same as Prozac? Is there a difference between Prozac and Zoloft, or other SSRIs?

In fact, each of these drugs has a slightly different active ingredient. As we know, Prozac depends on the active ingredient fluoxetine. Meanwhile, Zoloft has the active ingredient sertraline, and Luvox has the active ingredient fluvoxamine. All these ingredients have the same basic purpose, but they affect the body in diverse ways. For example, Prozac has different withdrawal symptoms than Zoloft, Luvox side effects differ from Prozac’s, and Zoloft uses differ a bit as compared to Luvox uses. That’s why it’s important to apply the same level of critical thinking to every drug, regardless of how similar they might seem to others. Although Prozac, Zoloft and Luvox are all SSRIs, the smallest of differences could lead to a significant impact on a person’s health.

First, one is encourage to do one’s own due diligence in selecting treatment for depression, anxiety or other unwanted symptoms. That will be a good starting point for a discussion with a trusted healthcare provider.

Finding the Truth About Holistic Ways to Improve Mental Wellness Without Side Effects

Some people have reported success with Prozac and other SSRIs. And Prozac potentially has some therapeutic use as a bridge medication for coming safely off other drugs with a shorter half-life. However, many people have reported significant side effects and failures as well. Unfortunately, drug manufacturers often frame information towards the positive, despite what the research indicates. That’s why it’s extremely important to be a strong advocate for one’s own health, starting by becoming as well informed as possible about the pros and cons of medications. Where possible, learn more about drug-free alternate options that may be a better fit for your situation.

You can learn more about how a healthy gut can improve mental health, and the positive impact a clean and nutrient rich diet can have on mood. You can also learn how toxins from foods, water, air, chemicals in cleaners, and much more, can adversely affect mood and other features of mental health. These and additional topics are discussed in more detail in the links provided below.

Knowledge is a vital tool that could prevent unnecessary harm. And, knowledge can significantly impact your quality of life for the better. Additional recommended reading:
• Antidepressant Tapering Help | Holistic Weaning & Titration Support
• Antidepressant Alternatives | Natural Alternatives to Antidepressants
• Antidepressant Medication Withdrawal Support, Side-effects, Treatment

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Prozac FAQs

Is Prozac Addictive?

Although Prozac is generally considered non-addictive, a growing number of reports of drug dependence and abuse have been documented in the adverse drug reporting agencies in the US and in Europe.18

Can Prozac Cause Euphoria?

Euphoria is not commonly associated with SSRI medications. However, a research study out of Sweden observed euphoria has been reported as a rare effect in the elderly population but not in other age groups.19

Can Prozac Cause Emotional Blunting?

Yes. SSRIs are known for an adverse reaction known as emotional blunting or numbness. Up to 60% of Prozac users report this phenomenon.20

Can Prozac Cause Persisting Sexual Dysfunction?

Yes. Post-SSRI sexual dysfunction (PSSD) is an adverse outcome reported in a significant percentage of people taking Prozac or other SSRI antidepressants, and is recognized by the European Medical Agency, who concluded that PSSD is a medical condition that persists even after discontinuation of SSRI medications.21

How Were Rodents Used to determine the Effectiveness of SSRIs on Depression?

Scientists induced stress on rodents, for example maternal separation, and assessed the therapeutic value of antidepressants by noting if the rodents’ depressive characteristics improved after treatment. Also, in some animal studies, the animals were killed after antidepressant treatment, and the amount of serotonin or other chemical of interest measured. However, the results from the whole battery of these animal tests were mixed, and inconclusive, with some showing increased, decreased, or no change at all in chemicals in various regions of the brain.22

Of perhaps greater importance, serotonin levels in mice were shown to decrease in areas of the mouse brain, after chronic treatment (the study ran approximately 6 weeks) of daily dosing with SSRI medications including fluoxetine and paroxetine.9

Are there Effective, Drug-free Ways to Help Depression?

Yes. There are many proven effective methods to get relief from symptoms like depression and others including anxiety, insomnia, and more. For more information you can visit these links:
Antidepressant Alternatives
Alternatives to Prozac

How Long Should a Person Take SSRIs like Prozac?

There is limited guidance published in the medical literature on how long a person should continue to take SSRIs like Prozac. The decisions about whether to continue to take or to quit taking SSRI medications warrant careful discussion with the prescriber. Issues to discuss can include adverse effects, worsening symptoms, newly emerging symptoms, and whether there has been therapeutic improvement.

Also important to consider is the potential harshness of withdrawals, which can increase with the amount of time a person has been taking Prozac or any other antidepressant.23

Sources:

1. NIMH Binge Eating Disorder [archived] last reviewed 2010 [cited 2026 Mar 17]

2. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2023 Aug;28(8):3243-3256. doi: 10.1038/s41380-022-01661-0. Epub 2022 Jul 20. PMID: 35854107; PMCID: PMC10618090. [cited 2026 Mar 17]

3. Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: from monoamines to glutamate. Exp Clin Psychopharmacol. 2015 Feb;23(1):1-21. doi: 10.1037/a0038550. PMID: 25643025; PMCID: PMC4428540. [cited 2026 Mar 17]

4. Salomon RM, Miller HL, Krystal JH, Heninger GR, Charney DS. Lack of behavioral effects of monoamine depletion in healthy subjects. Biol Psychiatry. 1997 Jan 1;41(1):58-64. doi: 10.1016/0006-3223(95)00670-2. PMID: 8988796. [cited 2026 Mar 17]

5. Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. Int J Tryptophan Res. 2019 Sep 9;12:1178646919873925. doi: 10.1177/1178646919873925. PMID: 31523132; PMCID: PMC6734608. [cited 2026 Mar 17]

6. Jones LA, Sun EW, Martin AM, Keating DJ. The ever-changing roles of serotonin. Int J Biochem Cell Biol. 2020 Aug;125:105776. doi: 10.1016/j.biocel.2020.105776. Epub 2020 May 29. PMID: 32479926. [cited 2026 Mar 17]

7. Chen Y, Xu J, Chen Y. Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. 2021 Jun 19;13(6):2099. doi: 10.3390/nu13062099. PMID: 34205336; PMCID: PMC8234057. [cited 2026 Mar 17]

8. Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/ [cited 2026 Mar 17]

9. Siesser WB, Sachs BD, Ramsey AJ, Sotnikova TD, Beaulieu JM, Zhang X, Caron MG, Gainetdinov RR. Chronic SSRI treatment exacerbates serotonin deficiency in humanized Tph2 mutant mice. ACS Chem Neurosci. 2013 Jan 16;4(1):84-8. doi: 10.1021/cn300127h. Epub 2012 Oct 1. PMID: 23336047; PMCID: PMC3547473. [cited 2026 Mar 17]

10. Science History Institute Biographies Fuller, Wong, Molloy published ND [cited 2026 Mar 17]

11. Das A, Pharmaceutical industry and the market: The case of Prozac and other antidepressants, Asian Journal of Psychiatry, Volume 4, Issue 1, 2011, Pages 14-18, ISSN 1876-2018, [cited 2026 Mar 17]

12. FDA drug label Prozac (fluoxetine hydrochloride) first approval 1987 [cited 2026 Mar 17]

13. Eli Lily Patient & Prescriber Information Prozac (fluoxetine hydrochloride) oral capsules, Antidepressant, Antiobsessional, Antibulimic, published 1989, revised 2021 [cited 2026 Mar 17]

14. Kondro W. UK bans, Health Canada warns about antidepressants. CMAJ. 2004 Jul 6;171(1):23. doi: 10.1503/cmaj.1040981. PMID: 15238484; PMCID: PMC437670. [cited 2026 Mar 17]

15. Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine (Baltimore). 2000 Jul;79(4):201-9. doi: 10.1097/00005792-200007000-00001. PMID: 10941349. [cited 2026 Mar 17]

16. Prozac: FDA approved Medication Guide for Patients published online 2009 Eli Lily & co. [cited 2026 Mar 17]

17. Maitland S, Baker M. Serotonin syndrome. Drug Ther Bull. 2022 Jun;60(6):88-91. doi: 10.1136/dtb.2021.000032. Epub 2022 May 12. PMID: 35551099. [cited 2026 Mar 17]

18. Chiappini S, Vickers-Smith R, Guirguis A, Corkery JM, Martinotti G, Schifano F. A Focus on Abuse/Misuse and Withdrawal Issues with Selective Serotonin Reuptake Inhibitors (SSRIs): Analysis of Both the European EMA and the US FAERS Pharmacovigilance Databases. Pharmaceuticals (Basel). 2022 May 1;15(5):565. doi: 10.3390/ph15050565. PMID: 35631391; PMCID: PMC9146999. [cited 2026 Mar 17]

19. Spigset O. Adverse reactions of selective serotonin reuptake inhibitors: reports from a spontaneous reporting system. Drug Saf. 1999 Mar;20(3):277-87. doi: 10.2165/00002018-199920030-00007. PMID: 10221856. [cited 2026 Mar 17]

20. Price J, Cole V, Goodwin GM. Emotional side-effects of selective serotonin reuptakeinhibitors: qualitative study. British Journal of Psychiatry. 2009;195(3):211-217. doi:10.1192/bjp.bp.108.051110 [cited 2026 Mar 17]

21. Peleg LC, Rabinovitch D, Lavie Y, Rabbie DM, Horowitz I, Fruchter E, Gruenwald I. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev. 2022 Jan;10(1):91-98. doi: 10.1016/j.sxmr.2021.07.001. Epub 2021 Oct 7. PMID: 34627736. [cited 2026 Mar 17]

22. Bremshey, S., Groß, J., Renken, K., & Masseck, O. A. (2024). The role of serotonin in depression—A historical roundup and future directions. Journal of Neurochemistry, 168, 1751–1779. https://doi.org/10.1111/jnc.16097& [cited 2026 Mar 17]

23. Thom RP, Alexander JL, Baron D, Garakani A, Gross L, Pine JH, Radhakrishnan R, Slaby A, Sumner CR. Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough? J Psychiatr Pract. 2021 Sep 16;27(5):361-371. doi: 10.1097/PRA.0000000000000578. PMID: 34529602. [cited 2026 Mar 17]

Originally Published November 14, 2025 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Never start, stop, or change a prescription medication without consulting a qualified healthcare professional who understands your medical history. If you are experiencing an immediate medical or safety emergency, call 911.