Suicide, depression and

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. 

It is likely that in the future a prospective investigation of suicidality in every regulatory trial will be required, and it is also possible that patients will need to be screened for suicidality, depression, and anxiety before randomization [36 ]. 

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. 

Naltrexone is contraindicated in those with a hypersensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C). Naltrexone is used cautiously in those with a narcotic addiction in patients with cardiovascular disease, acute hepatitis, liver failure, or depression and in patients who are suicidal. Naltrexone is used cautiously during lactation. 

The preadministration assessments of the outpatient are basically die same as diose for the hospitalized patient. The nurse obtains a complete medical history and a history of die symptoms of the depression from die patient, a family member, or die patient s hospital records. During die initial interview, die nurse observes die patient for symptoms of depression and die potential for suicide The initial physical assessment also should include the patient s vital signs and weight. 

Instructs in signs and symptoms of behavioral changes indicative of therapeutic effectiveness or increasing depression and suicidal tendencies. 

COMMENT It is interesting in that letter that George Greer wrote to me informally, off the record, that he had seen 10 patients in psychotherapy who had been treated extensively with fenfluramine for dieting. And, after several weeks on fenfluramine, they became very depressed, and two of them committed suicide. So that is a very serious consideration. 

Psychiatric adverse effects occur frequently and may include irritability, depression, and rarely, suicidal ideation. Individuals with a history of uncontrolled psychiatric disorders must weigh the risk versus benefit of treatment, as interferon may exacerbate or worsen the psychiatric condition. Patients who develop mild to moderate symptoms may require antidepressants or anxiolytics. Those with severe symptoms including suicidal ideation should have the treatment discontinued immediately.43... 

Differentiating between depression and dementia can be difficult, so symptoms of depression should be documented for several weeks prior to initiating therapy for the treatment of depression with AD. Citalopram and sertraline are recommended as first-line agents because of their efficacy in placebo-controlled trials.49 Indications for the use of antidepressants include depression characterized by poor appetite, insomnia, hopelessness, anhedonia, withdrawal, suicidal thoughts, and agitation. 

Risk of suicidality—Be alert to symptoms of worsening depression and suicidality. 

The mean age of onset of bipolar disorder is 20, although onset may occur in early childhood to the mid-40s.1 If the onset of symptoms occurs after 60 years of age, the condition is probably secondary to medical causes. Early onset of bipolar disorder is associated with greater comorbidities, more mood episodes, a greater proportion of days depressed, and greater lifetime risk of suicide attempts, compared to bipolar disorder with a later onset. Substance abuse and anxiety disorders are more common in patients with an early onset. Patients with bipolar disorder also have higher rates of suicidal thinking, suicidal attempts, and completed suicides. 

Lifetime prevalence rates of psychiatric comorbidity co-existing with bipolar disorder are 42% to 50%.16 Comorbidities, especially substance abuse, make it difficult to establish a definitive diagnosis and complicate treatment. Comorbidities also place the patient at risk for a poorer outcome, high rates of suicidal-ity, and onset of depression.2 Psychiatric comorbidities include ... 

Electroconvulsive therapy (ECT) is the application of prescribed electrical impulses to the brain for the treatment of severe depression, mixed states, psychotic depression, and treatment-refractory mania in patients who are at high risk of suicide. It also may be used in pregnant women who cannot take carbamazepine, lithium, or divalproex. 

Suicidal thoughts are one of the symptoms of depression. Paradoxically, one of the best-publicized dangers of SSRIs is their potential to increase the risk of suicide. This heightened risk is especially well established for children, adolescents and young adults. In their most recent analysis of the data, the FDA concluded that, when compared to placebos, SSRIs double the risk of suicidal thoughts and behaviour in depressed patients up to the age of 24/ There also seems to be an increased risk for people who are older than 24, but the interpretation of these data is still disputed.8... 

In the past several decades there has been increased incidence of depression, which motivated Gerald Klerman to describe this era as the age of melancholia [5], The lifetime prevalence of depression in the U.S. is higher in women (21.3%) than in men (12.7%). Although the rates of major depression vary across the world, data from fifty countries support the notion that this disease is the fourth leading cause of disability worldwide (second in developed countries) [3]. Longitudinal studies verify that the typical course of the disease is recurrent, with periods of recovery and periods of depression symptoms however, approximately 17% of patients have a chronic unremitting disease [6], Depression is the major cause of suicidal behavior and the rate of suicidal attempts has been estimated to be around 56% in depressed patients [7]. 

Mann, J. J., Huang, Y., Underwood, M. D. et al. A serotonin transporter gene promoter polymorphism (5-HTTLPR) and prefrontal cortical binding in major depression and suicide. Arch. Gen. Psych. 57 729-738, 2000. 

Mann, J. J., Malone, K. M., Sweeney, J. A. et al. Attempted suicide characteristics and cerebrospinal fluid amine metabolites in depressed inpatients. Neuropsychopharm. 15 576-586,1996. 

Mann, J. J. Role of the serotonergic system in the pathogenesis of major depression and suicidal behavior. Neuropsychopharm. 21 99S-105S, 1999. 

Implications of the prototypic classification method are that categories within the system will possess fuzzy boundaries. Individuals within a category will be somewhat heterogeneous and may not share any common features. In our depression example, a prototypic classification scheme may yield a diagnosis of depression in one patient who shows agitation, anhedonia, and suicidal ideation and the same diagnosis in another patient who shows sadness, fatigue, worthlessness, and decreased appetite. 

The basic strategy in using taxometric procedures is to presume a taxon— for example, depression. Next, we are required to conjecture the presumed taxon s indicators—sadness, anhedonia, and suicidality. Presume and conjecture based on what Clinical experience, intuition, past theory and research. .. it really does not matter. The presuming and conjecturing take place in what Popper (1959) called the context of discovery, where ideas, theories, and hypotheses are developed from any source. The empirical evaluation of these ideas, however, takes place in Popper s context of justification when the question is a taxometric one, the context of justification involves taxometric analyses. 

If a family member notices any of the symptoms previously mentioned in a loved one, then it may be that the loved one is depressed and should be evaluated by a mental health professional. If a loved one is expressing suicidal thoughts, or it is discovered that he or she has put his or her affairs in order (has sold or given away significant amounts of personal property, written a will, settled debts, etc.), then it would be critical to get help for that person as quickly as possible. Suicide is a major concern with people who abuse drugs, since a majority of suicides in the United States are attempted under the influence of drugs or alcohol. 

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. 

Anorexia nervosa sufferers can exhibit sudden angry outbursts or become socially withdrawn. One in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, other medical complications, or suicide. Clinical depression and anxiety place many individuals with eating disorders at risk for suicidal behavior. 

Lithium is the simplest therapeutic agent for the treatment of depression and has been used for over 100 years—lithium carbonate and citrate were described in the British Pharmacopoeia of 1885. Lithium therapy went through periods when it was in common use, and periods when it was discouraged. Finally, in 1949, J.J.F. Cade reported that lithium carbonate could reverse the symptoms of patients with bipolar disorder (manic-depression), a chronic disorder that affects between 1% and 2% of the population. The disease is characterized by episodic periods of elevated or depressed mood, severely reduces the patients quality of life and dramatically increases their likelihood of committing suicide. Today, it is the standard treatment, often combined with other drugs, for bipolar disorder and is prescribed in over 50% of bipolar disorder patients. It has clearly been shown to reduce the risk of suicide in mood disorder patients, and its socioeconomic impact is considerable—it is estimated to have saved around 9 billion in the USA alone in 1881. 

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