Suicidality obsessive

Case Reports of SSRI-induced Obsessive Suicidality and Aggression in Adults... 

On the basis of the literature and my clinical experience, the syndrome of SSRI-induced obsessive suicidality and violence includes many, and sometimes all, of the following ... 

Although genetic influences on the dynamics of drug response have been studied in a wide range of disorders, most of the studies have been carried out in only the past few years. Disorders and behaviors studied include Alzheimer s disease, schizophrenia, depression, suicide, anxiety, obsessive-compulsive disorder (OCD), substance abuse, smoking, and alcoholism. Across these disorders, however, there has been a focus on only a handful of neuroeffector systems. These include apolipoprotein and the cholinergic system (in Alzhei-... 

The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) is widely distributed in the CNS, subsuming a variety of functions including drive satiety, mood, aggression, anxiety, and compulsive and impulsive behaviors. It may be an important neurotransmitter in psychiatric symptoms commonly associated with PTSD such as aggression, obsessive/intrusive thoughts, alcohol and substance abuse, and suicidal behavior (Friedman, 1990). Suicidal behavior is known to be associated with both childhood maltreatment and low 5-HT functioning (Van der Kolk et ah, 1991 Benkelfat,... 

His final radio play was To Have Done with the Judgment of God. Artaud wrote this odd piece while in psychiatric institutions, where he was essentially tortured with excessive electroshock and other therapies. He wrote, I myself spent nine years in an insane asylum, and I never had the obsession of suicide, but I know that each conversation with a psychiatrist, every morning at the time of his visit, made me want to hang myself, realizing that I would not be able to cut his throat. ... 

A number of clinical reports have described a syndrome of obsessive SSRI-induced suicidality and aggression that seems particular to these drugs, starting with Teicher et al. (1990). These cases bear some similarity to akathisia-driven suicidality, but compulsion toward self-harm is not accompanied by the specific symptoms of akathisia. They summarized, Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment (p. 207). Additional cases and potential mechanisms of action were analyzed by Teicher et al. (1993). 

Goder, R., Friege, L., Treskov, V., Grohmann, R., Aldenhoff, J. (2000). Association of paroxetine with suicide attempt in obsessive-compulsive disorder. Pharmacopsychiatry, 33, 116-117. 

Panic disorders, with or without agoraphobia, affect 1.6% of the adult population (>3,000,000 people) in the United States at some time in their lives. In panic disorder, brief episodes of fear are accompanied by multiple physical symptoms, such as terror, fear of dying, heart palpitations, difficulty in breathing, and dizziness. Panic attacks recur and the victim develops an intense fear of having another attack, which is termed anticipatory anxiety. In addition, the victim may develop irrational fears, called phobias, that relate to situations in which a panic attack has occurred. This condition may coexist with other phobias (agoraphobia, simple phobia, social phobia), depression, obsessive-compulsive disorder, alcohol and drug abuse, suicidal tendencies and irritable bowel syndrome. 

Augmentation is called for when there is partial or non-response to the above approaches. Combinations of SSRIs with buspirone, clonazepam, clonidine, inositol, lithium, pindolol, olanzapine, risperidone, trazodone, tryptophan, and venlafaxine have been reported, with limited benefit. To date, only two augmenting agents have been found to be effective in double-blind studies risperidone and pindolol. Augmentation of SSRIs with clomipramine (or vice versa) is a common practice in non-responders however, this combination may lead to a substantial increase in the level of tricyclics in the blood and/or increase the risk of serotonin syndrome. Phenelzine may be helpful in symmetry-related or other atypical obsessions. Electroconvulsive therapy (ECT) should be reserved for severely depressed and suicidal OCD patients. Neurosurgery is the last resort current operations include anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The outcome of such operations is questionable. 

Serotonin has been found to influence sleeping, the regulation of body temperature, and sensory perception, but its exact role in mental illness is not yet clear. Unusually low levels of 5-hydroxyindoleacetic acid, a product of serotonin utilization, are characteristically found in the spinal fluid of victims of violent suicide. Drugs that mimic serotonin are sometimes used to treat depression, anxiety, and obsessive-compulsive disorder. Serotonin blockers are used to treat migraine headaches and relieve the nausea that accompanies cancer chemotherapy. A better understanding of the biochemistry of the brain may lead to better medications for treating various forms of mental illness. 

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