Pharmacotherapy of Suicidal Patients

Öz

The mainstay of the pharmacotherapeuticapproach of suicidal patients is the treatment ofunderlying disorder. Rational use of pharmacotherapeutic agents such as antidepressants,lithium, mood-stabilizing anticonvulsant agents,antipsychotics and anxiolitics, which are themain options in the treatment of psychiatric disorders, not only treat the underlying disorderbut also be helpful to rapidly address insomnia,anxiety, and agitation, which are additional riskfactors for suicide. Antisuicidal effects of lithiumin patients with bipolar disorders and clozapinein patients with schizophrenia are well established. After publication of several case reportssuggesting that specific serotonin reuptakeinhibitor (SSRI) antidepressants might be associated with increased risks of aggressive orimpulsive acts, including suicide, a number ofinvestigators retrospectively analyzed clinicaltrial data to determine whether suicidality and/orsuicide rates are increased with SSRI treatment.These studies did not show evidence that suicide or suicidality is increased by treatment withspecific types of antidepressants. Further largescaled prospective, controlled studies arerequired for a more general view on pharmacotherapeutic options in suicidal patients

Anahtar Kelimeler

• Suicidality, pharmacotherapy,antidepressants, lithium, antipsychotics

İntihar Eğilimi Olan Hastalarda İlaç Tedavisi

Öz

İntihar eğilimi olan kişide ilaç tedavisiyaklaşımının temel belirleyicisi altta yatan bozukluktur. Psikiyatrik bozuklukların tedavisindebaşlıca ilaç tedavisi seçenekleri olan antidepresanlar, lityum, duygudurum düzenleyici antikonvülzan ilaçlar, antipsikotikler ve anksiyolitiklerindoğru bir şekilde kullanımı bir yandan altta yatanhastalığı tedavi ederken, diğer yandan intihariçin risk faktörleri olan uykusuzluk, anksiyete veajitasyonu azaltabilir. Bipolar bozukluk hastalarında lityum ve şizofreni hastalarında klozapinintiharı önleyici etkinlikleri kanıtlanmış psikoterapötik ilaçlardır. Özgül serotonin gerialımengelleyicileri (SSRI) grubu antidepresan kullanan kişilerde ortaya çıkan saldırgan, tepiseldavranışlar ve intiharları bildiren birkaç olgubildiriminin yayınlanması sonrasında, bazıaraştırmacılar geriye dönük olarak intihar eğilimive/veya intihar hızlarındaki artışın SSRI tedavisiile ilişkili olup olmadığını araştırmıştır.

Kaynakça

1. Altindag A, Ozkan M, Oto R (2005) Suicide in Batman, Southeastern Turkey. Suicide Life Threat Behav, 35: 478-82.
2. American Psychiatric Association (2003) Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors. Am J Psychiatry,
3. Appleby L, Cooper J, Amos T, Faragher B (1999) Psychological Autopsy Study of Suicides by People Aged Under 35. Br J Psychiatry, 175: 168-74.
4. Baldessarini RJ, Tondo L, Hennen J (2003) Lithium Treatment and Suicide Rsk in Major Affective Disorders: Update and New Findings. J Clin Psychiatry, 64:44-52.
5. Bauer M, Bschor T, Kunz D ve ark (2000) Double-Blind, Placebo-Controlled Trial of the use of Lithium to Augment Antidepressant Medication in Continuation Treatment of Unipolar Major Depres- sion. Am J Psychiatry, 157:1429-1435.
6. Beasley CM Jr, Dornseif BE, Bosomworth JC ve ark (1991) Fluoxetine and Suicide: A Meta-Analysis of Controlled Trials of Treatment for Depression. BMJ, 303:685-692.
7. Beasley CM Jr, Potvin JH, Masica DN ve ark (1992) Fluoxetine: No Association with Suicidality in Obsessive-Compulsive Disorder. J Affect Disord, 24:1–10.
8. Campbell M, Perry R, Green WH (1984) Use of Lithium in Children and Adolescents. Psychosoma- tics, 25:95-101.

9. Campbell M, Adams PB, Small AM ve ark (1995) Lithium in Hospitalized Aggressive Children with Conduct Disorder: A Double-Blind and Placebo- Controlled Study. J Am Acad Child Adolesc Psychiatry, 34:445-453.
10. Cheeta S, Schifano F, Oyefeso A ve ark (2004) Antidepressant-Related Deaths and Antidepressant Prescriptions in England and Wales, 1998-2000. Br J Psychiatry, 184:41-47.
11. Cipriani A, Pretty H, Hawton K, ve ark (2005) Lithium in the Prevention of Suicidal Behavior and All- Cause Mortality in Patients with Mood Disorders: A Systematic Review of Randomized Trials. Am J Psychiatry, 162:1805-1819.
12. Collins JC, McFarland BH (2007) Divalproex, Lithium and Suicide Among Medicaid Patients with Bipolar Disorder. J Affect Disord (baskıda).
13. Goldberg JF, Allen MH, Miklowitz DA, ve ark (2005) Suicidal Ideation and Pharmacotherapy Among STEP-BD Patients. Psychiatr Serv, 56:1534- 1540.
14. Goodwin FK, Murphy DL, Dunner DL ve ark (1972) Lithium Response in Unipolar Versus Bipolar Depression. Am J Psychiatry, 129:44-47.
15. Goodwin FK, Fireman B, Simon GE ve ark (2003) Suicide Risk in Bipolar Disorder During Treatment with Lithium and Divalproex. JAMA, 290:1467-1473.
16. Guzzetta F, Tondo L, Centorrino F, ve ark (2007) Lithium Treatment Reduces Suicide Risk in Recurrent Major Depressive Disorder. J Clin Psychiatry, 68:380- 383.
17. Healy D, Langmaak C, Savage M (1999) Suicide in the Course of the Treatment of Depression. J Psychopharmacol, 13:94-99.
18. Khan A, Leventhal RM, Khan S ve ark (2002) Suicide Risk in Patients with Anxiety Disorders: A Meta-Analysis of the FDA Database. J Affect Disord, 68:183-190.
19. Khan A, Khan S, Kolts R ve ark (2003) Brown WA: Suicide Rates in Clinical Trials of SSRIs, Other Antidepressants, and Placebo: Analysis of FDA Reports. Am J Psychiatry, 160:790-792.
20. Kragh-Sorensen P (1993) Pharmacotherapy of the Suicidal Patient. Acta Psychiatr Scand, 371:57- 59.
21. Malone RP, Delaney MA, Luebbert JF ve ark (2000) A Double-Blind Placebo-Controlled Study of Lithium in Hospitalized Aggressive Children and Adolescents with Conduct Disorder. Arch Gen Psychiatry, 57:649-654.
22. Mann JJ (2002) A Current Perspective of Sui- cide and Attempted Suicide. Ann Intern Med, 136:302-311.
23. McElroy SL, Kotwal R, Kaneria R, ve ark (2006) Antidepressants and Suicidal Behavior in Bipolar Disorder. Bipolar Disord, 8:596-617.
24. Meltzer HY, Okayli G (1995) Reduction of Suici- dality During Clozapine Treatment of Neuroleptic- Resistant Schizophrenia: Impact on Risk-Benefit Assessment. Am J Psychiatry, 152:183-190.
25. Morrison SD, Erwin CW, Gianturco DT ve ark (1973) Effect of Lithium on Combative Behavior in Humans. Dis Nerv Syst, 34:186-189.
26. Muller-Oerlinghausen B, Berghofer A (1999) Antidepressants and Suicidal Risk. J Clin Psychiatry,
27. Reith D, Monteleone JP, Whyte IM, ve ark (1998) Features and Toxicokinetics of Clozapine in Overdose. Ther Drug Monit, 20:92-7.
28. Rothschild AJ, Locke CA (1992) Re-Exposure to Fluoxetine After Serious Suicide Attempts by Three Patients: the Role of Akathisia. J Clin Psychiatry, 52:491-492.
29. Sudak HS. Suicide. Psychiatric Emergencies. In: Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 8th. Edition, Vol. 1, Lippincott Williams & Wilkins, Philadelphia, 2005.
30. Sayıl I (1997) Review of Suicide Studies in Turkey. Crisis, 18(3):124-127.
31. Sheard MH, Marini JL, Bridges CI ve ark (1976) The Effect of Lithium on Impulsive Aggressive Beha- vior in Man. Am J Psychiatry, 133:1409-1413.
32. Teicher MH, Glod C, Cole JO (1990) Emergence of Intense Suicidal Preoccupation During Fluoxetine Treatment. Am J Psychiatry, 147:207-210.
33. Thies-Flechtner K, Muller-Oerlinghausen B, Seibert W ve ark (1996) Effect of Prophylactic Treat- ment on Suicide Risk in Patients with Major Affective Disorders. Data From A Randomized Prospective Trial. Pharmacopsychiatry, 29:103-107.
34. Tollefson GD, Rampey AH, Beasley CM ve ark (1994) Absence of A Relationship Between Adverse Events and Suicidality During Pharmacotherapy for Depression. J Clin Psychopharmacol, 14:163-169.
35. Treiser SL, Cascio CS, O'Donohue TL ve ark (1981) Lithium Increases Serotonin Release and Decreases Serotonin Receptors in the Hippocampus. Science, 213:1529-1531.
36. Tupin JP, Smith DB, Clanon TL ve ark (1973) The Long-Term use of Lithium in Aggressive Priso- ners. Compr Psychiatry, 14:311-317.
37. Unverir P, Atilla R, Karcioglu O ve ark (2006) A Retrospective Analysis of Antidepressant Poisonings in the Emergency Department: 11-Year Experience. Hum Exp Toxicol, 25:605-612.
38. Üstün N, Aker T, Karamustafalıoğlu O (2002) Bir Olgu Nedeniyle Olanzapinin Güvenilirliği. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi, 10:171-176.
39. Watanabe S, Ishino H, Otsuki S (1975) Double- Blind Comparison of Lithium Carbonate and Imipra- mine in Treatment of Depression. Arch Gen Psychiatry, 32:659-668.
40. Worrall EP, Moody JP, Peet M ve ark (1979) Controlled Studies of the Acute Antidepressant Effects of Lithium. Br J Psychiatry, 135:255-262.
41. Yerevanian BI, Koek RJ, Mintz J (2003) Lithium, Anticonvulsants and Suicidal Behavior in Bipolar Disorder. J Affect Disord, 73:223-228.
42. Yerevanian BI, Koek RJ, Mintz J (2007) Bipolar Pharmacotherapy and Suicidal Behavior. Part I: Lithium, Divalproex and Carbamazepine. J Affect Disord (baskıda).