Suicidal feelings

The symptoms of Ritalin and amphetamine withdrawal can include psychosis, depression, exhaustion, withdrawal, irritability, suicidal feelings, excitability, euphoria, and hyperactivity. 

Although akathisia by definition usually involves a hyperactive movement component, clinical experience indicates that it may be accompanied with a feeling of jitteriness without actual physical movement that is, the same jittery, agitated subjective experience, accompanied by irritability, violence, or suicidal feelings, can occur without the specific component of feeling driven to move about. Indeed, on earlier occasions, the individual may have experienced the associated compulsion toward hyperactivity. Healy (1994) made similar observations. 

Masand et al. (1991) reported on two cases of suicidality in association with fluoxetine. One of the patients suffered from akathisia. In both cases, the suicidal feelings subsided shortly after stopping the medication. Neither patient had prior suicidal ideation. Both developed violent fantasies (hanging and jumping out a window). 

Creaney et al. (1991) described two patients who became suicidal on SSRIs. One patient developed dysphoria and manic symptoms on fluoxetine and then developed a similar syndrome, this time with suicidal feelings, on fluvoxamine. Another patient became intensely and violently suicidal 16 days after starting fluoxetine. 

Like any addictive stimulant, methylphenidate and amphetamine can cause withdrawal symptoms such as crashing with depression, exhaustion, withdrawal, irritability, and suicidal feelings. However, parents and teachers almost never recognize a withdrawal reaction when their student or child gets upset after missing a single dose. Instead, they mistakenly believe that the child needs to be kept on the medication. 

Hospitalized at age 15 for physical aggression towards parents, suicidality, and running away does not remember if she was placed on medication or if she was given a diagnosis admits history of sleep disturbance that alternates between hyposomnia and hypersomnia and moodiness, when she shifts from feeling "on top of the world" to very depressed, "like I m a nobody."... 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Following initial assessment, including evaluation of potential suicidality, support systems, and need for inpatient versus outpatient treatment, MW was hospitalized briefly, then followed in the community on medication along with psychotherapy. She has abstained from illicit substances and has returned to her job. She has responded well to treatment with sustained-release lithium carbonate 900 mg once daily at bedtime with a snack. Steady-state 12-hour serum lithium concentrations have stabilized at 0.9 mEq/L (0.9 mmol/L). She now returns to clinic for routine followup. She has tolerated the lithium except for a mild tremor and a gain of 7 pounds (3.2 kg). She is willing to accept these side effects for now, but asks about how long she must take medication since she is now feeling well. 

Finally, all of the trials in the FDA data set included the same measure of depression, a physician-rated scale called the Hamilton Rating Scale for Depression (HRSD). The Hamilton scale is completed by doctors based on interviews and observations of patients. The doctor rates the patient s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example, one point is given if the patient feels that life is not worth living, and four points are scored if the person has made a serious suicide attempt. The result is a numerical score that can range from o to 51. 

Finally, one of the most difficult types of crises to address is the death of a client. People with drug problems often lead very risky lives, and the threat of death may be ever present with such clients. People who use drugs are at risk from infectious diseases such as hepatitis and AIDS, from suicide and homicide, and from accidents. The saddest events in my professional career have been associated with losing a client. Such losses burden professionals, who may assume some level of responsibility for the death or may feel a sense of loss in not being able to meet with the client any more. Be aware that caregivers sometimes need care themselves, and this is one particular situation in which that may be true. Do not be shy about seeking help if you feel that the death of a client has adversely affected your professional or personal life. 

I sometimes give myself permission to have knock-down-drag-out major depressive episodes, with suicidal thoughts and everything, because that s how sad I feel, or how hurt. But I would not take my life. I can t disappoint Jehovah, and I could not do that to my family or friends. I know the depression will pass. 

The diagnosis of mania is made on the basis of clinical history plus a mental state examination. Key features of mania include elevated, expansive or irritable mood accompanied by hyperactivity, pressure of speech, flight of ideas, grandiosity, hyposomnia and distractibility. Such episodes may alternate with severe depression, hence the term "bipolar illness", which is clinically similar to that seen in patients with "unipolar depression". In such cases, the mood can range from sadness to profound melancholia with feelings of guilt, anxiety, apprehension and suicidal ideation accompanied by anhedonia (lack of interest in work, food, sex, etc.). 

Feelings of isolation were common among interviewees at both historically black colleges and universities and historically white colleges and universities. In instances where the chemists were the only persons of color in the department or perhaps the first ones ever appointed to a faculty position in chemistry, many became discouraged and sometimes very depressed. Benjamin (1991) posits that the social isolation faced by many upwardly mobile African Americans often leads to stress, which can manifest itself in physiological disorders, such as hypertension, behavioral disorders, and even suicide. One Cohort V interviewee offered the following comments ... 

The contents of such illusions and hallucinations can occasionally become extremely threatening ( bad or bum trip ) the individual may feel provoked to turn violent or to commit suicide. Intoxication is followed by a phase of intense fatigue, feelings of shame, and humiliating emptiness. 

In turn, conditions characterized by the term depression include affective disorders, which are frequently accompanied by a number of other disturbances including unmotivated sorrow, sleep disorders, changes in appetite, various psychomotor disturbances, loss of interest in things once pleasurable, feelings of worthlessness, and often suicidal thoughts. 

Notify the physician of feelings of depression or thoughts of suicide... 

I know I m less depressed and irritable. My boyfriend says I m easier to take, but I m not sure this is really me. I feel like this poser [posing as another]. Like, every time I take my pills it reminds me that I m this fuck-up who can t manage her feelings on her own. I hated feeling suicidal, but hey, maybe that s more me. 

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