Fluoxetine administered intraperitoneally to sham-operated or adrenalectomized/castrated (ADX/CX) male rats dose-dependently (2.9-58 ,umol/kg i.p.) increased the brain content of the neurosteroid 3c-hydroxy-5a-pregnan-20-one (allopregnanolone, 3a,5a-TH PROG). The increase of brain 3a,5a-TH PROG content elicited by 58,umol/kg fluoxetine lasted more than 2 hr and the range of its extent was comparable in sham-operated (--3-10 pmol/g) and ADX/CX rats (2-9 pmol/g) and was associated with a decrease (from 2.8 to 1.1 pmol/g) in the 5a-pregnan-3,20-dione (5a-dihydroprogesterone, 5a-DH PROG) content. The pregnenolone, progesterone, and dehydroepiandrosterone content failed to change in rats receiving fluoxetine. The extent of 3a,5a-TH PROG accumulation elicited by fluoxetine treatment differed in various brain regions, with the highest increase occurring in the olfactory bulb. Importantly, fluoxetine failed to change the 3a,5ca-TH PROG levels in plasma, which in ADX/CX rats were at least two orders of magnitude lower than in the brain. Two other serotonin re-uptake inhibitors, paroxetine and imipramine, in doses equipotent to those of fluoxetine in inhibiting brain serotonin uptake, were either significantly less potent than fluoxetine (paroxetine) or failed to increase (imipramine) 3a,5ci-TH PROG brain content. The addition of 10 ,uM of 5a-DH PROG to brain slices of ADX/CX rats preincubated with fluoxetine (10 IuM, 15 min) elicited an accumulation of 3a,5a-TH PROG greater than in slices preincubated with vehicle. A fluoxetine stimulation of brain 3a,5ai-TH PROG biosynthesis might be operative in the anxiolytic and antidysphoric actions of this drug.Neurosteroids such as 3a-hydroxy-5a-pregnan-20-one (allopregnanolone, 3a,5a-TH PROG); pregnenolone (PREG) sulfate; and dehydroepiandrosterone (DHEA), sulfate, promptly decrease or increase brain excitability acting as potent positive (3a,5a-TH PROG) or negative (PREG sulfate, DHEA sulfate) allosteric modulators of y-aminobutyric acid (GABA) action at GABAA receptors (1-6). These discoveries have provided a new mechanism for brain GABAergic tone modification applicable to the treatment of various neuropsychiatric disorder symptoms (7,8). These include the anxiety and mood changes of the "late luteal dysphoria syndrome," associated with low progesterone (PROG) plasma levels (a steroid participating in 3a,5a-TH PROG biosynthesis) (8, 9).Though the prospect that neuroactive steroids could be used in the symptomatic treatment of specific neurological and psychiatric disorders has generated some enthusiasm, substantial difficulties prevent the therapeutic use of neurosteroids. For example, the systemic administration of 3a,5a reduced derivatives of PROG or androstenedione acting as positive allosteric modulators of GABA action at GABAA receptors, indicates that the doses required to elicit a clear anxiolytic, antidysphoric, and antiepileptic activity may also produce profound sedation, motor impairment, or ataxia (6,8,10). Two additional pharmacological actions that may li...