Suicidality depression-related

Rimonabant is an inverse agonist for the cannabi-noid receptor CBl. In 2006 rimonabant was approved in the European Union as an anti-obesity drug. The use of rimonabant after one year produces a modest weight loss of approximately 5%. However there are serious concerns over suicidality, depression and other related side effects associated with use of the drug. In Europe, rimonabant is now contraindicated for patients with severe depression. 

Strobel A, Gutknecht L, Rothe C, Reif A, Mossner R, Zeng Y, Brocke B, Lesch KP. Allelic variation in 5-HT 1A receptor expression is associated with anxiety- and depression-related personality traits. J. Neural Transm. 2003 110 1445-1453. Lemonde S, Turecki G, Bakish D, Du L, Hrdina PD, Bown CD, Sequeira A, Kushwaha N, Morris SJ, Basak A, et al. Impaired repression at a 5-hydroxytryptamine lA receptor gene polymorphism associated with major depression and suicide. J. Neurosci. 2003 23 8788-8799. 

Most adverse effects of reserpine are due to its effect on the CNS. Sedation and inability to concentrate or perform complex tasks are the most common adverse effects. More serious is the occasional psychotic depression that can lead to suicide. Depression usually appears insidiously over many weeks or months and may not be attributed to the drug because of the delayed and gradual onset of symptoms. Reserpine must be discontinued at the first sign of depression, which may last several months after the drug is discontinued. The risk of depression is likely dose related. Depression appears to be uncommon, but not unknown, with doses of 0.25 mg/day or less. The drug should never be given to patients with a history of depression. Other adverse effects include nasal stuffiness and exacerbation of peptic ulcer disease, which is uncommon with small oral doses. 

Anxiety disorders and insomnia represent relatively common medical problems within the general population. These problems typically recur over a person s lifetime (3,4). Epidemiological studies in the United States indicate that the lifetime prevalence for significant anxiety disorders is about 15%. Anxiety disorders are serious medical problems affecting not only quaUty of life, but additionally may indirecdy result in considerable morbidity owing to association with depression, cardiovascular disease, suicidal behavior, and substance-related disorders. 

About one person in 20 will suffer one or more episodes of major depression at some time during their life. Women are afflicted about twice as frequently as men. Major depressive episodes are life threatening. About 20% of victims end their lives by suicide. Susceptibility to major depression is family related. Although the genes that sensitize a person for major depressive illness have not been identified, it is clear that there is a genetic component to this disorder. 

Mood disorders represent a major public health concern around the globe. In the United States alone, the annual cost of major depression is over 40 billion dollars. Less than 30% of the total cost of depression is incurred through direct treatment. The remainder consists of the indirect hidden costs of lost productivity due to absenteeism and poor work efficiency, premature death from suicide or medical illness, and the uncounted losses related to a poor quality of life. 

Propoxyphene (dextropropoxyphene Darvon) is structurally related to methadone but is much less potent as an analgesic. Compared with codeine, propoxyphene is approximately half as potent and is indicated for the treatment of mild pain. It is not antipyretic or antiinflammatory like aspirin and is less useful than aspirin in most cases of mild pain. Toxicity from propoxyphene, especially in combination with other sedatives, such as alcohol, has led to a decrease in its use. Death following ingestion of alcohol in combination with propoxyphene can occur rapidly (within 20 minutes to 1 hour). The drug is not indicated for those with histories of suicide or depressive illnesses. 

Hospitalization for eating disorder depends on the weight status of the patient, the presence of medical complications, and the presence of related psychiatric comorbidities, such as depression, suicidal behavior, and OCD. Hospitalization for AN may be brief or extended. Inpatient brief hospitalization (7-14 days) is for patients who have (1) relapsed from previous treatment or have been ill for less than 6 months (2) a weight loss of 10%-15% from normal weight if they have relapsed, or 16%-20% if this is their first episode (3) hypokalemic alkalosis with serum potassium < 2.5 mEq/L and (4) cardiac arrhythmias. To promote rapid weight gain, patients can be placed on a liquid formula... 

Major depression is a significant risk factor for suicide. The presence of suicidal ideation should be assessed initially and repeatedly over the course of treatment. In this respect, depressive disorders are a major health care problem, contributing to 70% of suicide-related deaths (with a 15% mortality risk associated with suicide in untreated recurrent major episodes). 

Older persons account for one-third of all suicides in the United States even though this group represents only 12% of the population ( 36). Suicide is even more often related to major depression in the elderly than in younger individuals in whom other causes such as substance abuse, bipolar disorder, schizophrenia, and personality disorders often play a major role. In fact, suicide rates are highest in older white men relative to any other segment of the population. For example, white men older than 85 years age commit suicide 30 times as frequently as black women. 

Suicide—or attempted suicide—in eight users of anabolic steroids has been described in Germany the cases were related variously to hypomanic states during use of anabolic steroids or depression after withdrawal (39). Some of the users had committed acts of violence while using the drugs. In all cases, there were risk factors for suicidality and the drugs may simply have triggered the suicidal decision. 

Note AIDS is caused by HIV, which impairs both cellular and humoral immune functions, and this results in increased susceptibility to opportunistic infection and certain malignancies. The medical aspects of HIV infection include AIDS-related complex (weight loss, chronic diarrhea, fever, thrush, herpes zoster, fatigue), opportunistic infections and cancer, end-stage renal disease, blindness (cytomegalovirus), HIV encephalopathy, and dementia. The psychological aspects of HIV infection include major depression, regression, and suicidal impulses, delirium, substance abuse, antisocial personality, and bereavement. 

Horsten et al. examined the inverse relationship between cholesterol levels and death from violent causes, including suicide, in a group of 300 middle-aged healthy Swedish women [100]. The authors also investigated the association between cholesterol and other psychosocial factors (social support, vital exhaustion, and stressful life events), which are known to be related to depression. The results showed that women with low serum cholesterol, defined as the lowest tenth of the cholesterol distribution (<4.7 mmol/L or 180 mg/dL), reported significantly more depressive... 

Sideline. In Vienna s Zentralfriedhof, Ludwig Boltzmann (who died a suicide after a lifelong battle with depression) is commemorated with a cenotaph with the inscription "S k In W" his suicide probably was not related to the slow acceptance of his discoveries. 

In reality, since the short-term, company-run clinical trials were wholly unsuited to detecting suicidality, the risk had to be much more than modest to show up at all. In addition, Hammad et al. (2006) admitted to a fact that I had been insisting on for years in publications and testimony that the drug company s premier measure of suicidality, the Hamilton Depression (Ham-D) Scale, is useless in that regard. The investigator asks the subject questions from the scale, only one of which is related to suicidality. Obviously, the answers will depend on how seriously the question is asked, and rote questions are likely to elicit rote answers. The inventor of the Ham-D Scale did not himself believe that it could be used as a scientific tool in the manner that the drug companies have utilized it (Hamilton, 1960). 

STUDIES RELATED TO SSRI-INDUCED DEPRESSION AND SUICIDALITY IN ADULTS... 

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