Psychotropic Medication and Suicide Prevention

Antidepressants: As a pharmacological class, the antidepressants work far too slowly to be an apt choice as a suicide deterrent. The older cyclic agents can actually be fatal in overdose, particularly if combined with alcohol. This is because many of them block the actions of histamine, thereby producing marked sedation. Serotonin antidepressants, particularly the SSRIs, can increase suicidal thinking and behavior in patients under 24 years old, but they also probably decrease suicide deaths overall.

Anxiolytics: Though the benzodiazepines carry an attendant risk of tolerance development and dependence, as a class, they are generally safe unless combined with alcohol. Deaths in this instance are due to respiratory depression. These medications however, may be life saving in an acute suicidal episode when anxiety is prominent.

Lithium: Lithium has strong anti-suicidal properties. The risk of suicide in bipolar clients treated with lithium falls 10-fold. When lithium is discontinued, suicidal behavior increases 20-fold within the next 6-12 months. The anti-suicidal properties of lithium are not present with the anticonvulsant mood stabilizers such as Tegretol, Depakote.

Clozaril: The second-generation antipsychotic Clozaril (clozapine) also has strong anti-suicide properties. It is FDA approved as a suicide deterrent in clients with schizophrenia or schizoaffective disorder. Evidence of suicide protection is not as strong with the other antipsychotics.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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