Fluoxetine for Refractory Constipation

Inclusion Criteria: 1. individuals aged 18 to 70 years; 2. patients meeting the Rome IV diagnostic criteria for chronic constipation, defined by at least two symptoms: straining, lumpy or hard stools (Bristol Stool Scale types 1-2), incomplete evacuation, anorectal obstruction, need for manual maneuvers, or spontaneous bowel movements occurring less than three times per week. These symptoms must have persisted for a minimum of six months, with the diagnostic criteria being met for at least the past three months; 3. refractory constipation, defined as the use of at least three medications (including osmotic agents, laxatives, prokinetics, biofeedback and probiotics, surgery) for more than three months, with unsatisfactory treatment outcomes; 4. patients present indications for fluoxetine, such as comorbid depression; 5. patients who voluntarily provided informed consent prior to enrollment. Exclusion Criteria: 1. women who are pregnant or lactating; 2. presence of cardiovascular conditions, organ dysfunction, immune disorders, or infections; 3. concurrent gastrointestinal organic conditions such as tuberculosis, polyps, Crohn's disease, tumors, etc.; 4. prior abdominal surgeries; 5. use of psychotropic medications; 6) diagnosis of hypothyroidism or Parkinson's disease.