Fluoxetine, an antidepressant drug, has shown promise as a therapy in spinal cord injury (SCI), but the mechanism underlying this neuroprotection was unknown. Using a mouse contusion-injury model, Lee et al. show that fluoxetine prevents breakdown of the blood–spinal cord barrier by inhibiting activation of matrix metalloproteinases and maintaining tight-junction integrity. The study highlights fluoxetine as a promising therapy for brain injury and SCI.