3

(EDIT: Thanks for the comments - I'm working on improving references - apologies)

In patients with Borderline personality disorder or treatment resistant depression have what must be among the highest rates of suicide in mental health, excluding comorbidities. I will focus on BPD to simplify the question. Up to 10% are expected to have killed themselves, the study shows. (Treatment is often ineffective compared to other diseases with suicidal ideation).

Some long term medications are used in Asperger's to quell the overwhelming sensory percepts and the irritability, impulses and distress that transpires, leading to dangerous behaviours. Ie, the ASD patient's stress rises disproportionately due to oversensitivities, and partially developed coping mechanisms heighten risk of suicide. (References needed. Lots).

Long acting benzodiazepines are used to treat acute symptoms especially involving anxiety (stress). But I don't know why I can't find information on why medications such as Pregabalin are not cited as a long term treatment for persistent suicidal ideation but for anxiety.

I believe Pregabalin is offered on top of mood stabilizers for BPD patients to take the edge off self-destructive behaviours. The risk is Pregabalin itself has a high risk of causing suicidality. But this would be ignored until it occurs since obviously it would have been assessed as a probably benefit. (References needed - this might answer my question!)

But perhaps there are other meds with sedating action approved for long term use, used to treat suicidality?

Improve this question
10
  • 5
    This Q would be great for Psych&Neurosci, but it needs to be sourced first before migration. What do you mean by BPD of treatment resistant depression? And the highest rates of suicide? Depressed folks? Or treated folks? The first line is unclear. The benzo statement needs a resource. And the pregabalin for Aspeger's needs a source too. And lastly, and most importantly, what do sensory inputs have to do with suicidal thoughts? What is the rationale behind that? As it seems to be the core of the Q it needs background....
    – AliceD
    Commented Feb 18, 2019 at 8:11
  • 3
    ...For now, it would be closed over at Pcych&Neurosci, because questions need to be framed in Psych&Neurosci. This post is not (yet). FYI - the mods here inquired with us over at Psych&Neurosci to discuss migration.
    – AliceD
    Commented Feb 18, 2019 at 8:12
  • 5
    Welcome to MedicalSciences.SE! Please take the tour and read the help center. Just like Psychology.SE, for reasons mentioned in this post and in How to Ask, we also require prior research information when asking questions. As @AliceD asked, please help us to help you and edit your question to provide more information on what you have read on this subject, what made you ask this question, and any problems you are having understanding your research. If you found nothing, what did you Google?
    – Chris Rogers
    Commented Feb 18, 2019 at 11:09
  • 1
    I agree with the comments above. I just want to add that suicidal ideation is not necessarily a mental illness in itself; it is a symptom (a significant one) of mental illnesses like you describe. As far as I am aware, in psychiatry, medication are generally licensed to a diagnosis, not a symptom. Pregabalin for example is licensed for generalised anxiety disorder (and separately for neuropathic pain) but is not licensed for suicidal ideation (or for Asperger’s syndrome), at least not in the UK.
    – Chris
    Commented Feb 18, 2019 at 20:01
  • 1
    @Chris despite being licensed for diagnoses, medications are definitely prescribed in order to address specific significant aspects of those diagnoses, especially when there are good outcomes data to support the choice. Suicidality is one example, hypertension with asymptomatic left ventricular dysfunction is another. In both cases, you pick a drug that will reduce mortality because of the clinical features, not just the diagnosis.
    – De Novo
    Commented Feb 19, 2019 at 7:14

1 Answer 1

Reset to default
5

Effective treatment of suicidality involves treatment of any underlying disorder and multi-modal treatment to address the suicidality directly. For pharmacotherapy, there are few drugs that show clear reduction in suicides. An old population based retrospective study from Sweden suggests achieving an appropriate dose of SSRI may be effective, but it is, perhaps surprisingly, lithium that has the best data on reducing suicides. As far as anxiolytics are concerned, they aren't generally prescribed to reduce the risk of suicide.

Improve this answer
5
  • 2
    Good answer - thanks.
    – Chris
    Commented Feb 19, 2019 at 7:51
  • It is interesting that you mention SSRIs help with suicidality when Seroxat has increased suicidality - see also this NHS study report
    – Chris Rogers
    Commented Feb 19, 2019 at 7:53
  • 3
    @ChrisRogers yes, the SSRI issue is complicated, which is why I was careful about my wording. It seems that appropriate doses of SSRI may help, but the data isn't great. Inadequate treatment with SSRI clearly does not, and is a particular concern for young people, in whom it appears to increase suicide risk. The main take home here is that lithium has the best data on suicide reduction. A question about the risks and benefits of SSRIs for depression in different age groups would be more appropriate to delve into that, but if you have a suggestion for a specific edit here, I'm all ears.
    – De Novo
    Commented Feb 19, 2019 at 8:03
  • 2
    @ChrisRogers the risk of completing suicide is much higher for people whose depression is left untreated than those in treatment for it, even with the marginal-at-best increase in suicide risk reported in such studies. The black box warning, for example, is most likely attributable to the fact that initiation of an SSRI tends to relieve the vegetative symptoms of depression before the mood symptoms - meaning their energy level increases before their mood improves - and those who were just too fatigued to act on their suicidal ideations are at higher risk. Thus we counsel on that risk.
    – DoctorWhom
    Commented Feb 19, 2019 at 9:02
  • 4
    There seems to be a backlash against antidepressants when these studies come out, which is concerning, because untreated depression is a far greater suicide risk. As @DeNovo said, "effective treatment...involves....multi-modal treatment" and pharmacology is only one portion of effective treatment.
    – DoctorWhom
    Commented Feb 19, 2019 at 9:10

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service and acknowledge you have read our privacy policy.

Not the answer you're looking for? Browse other questions tagged or ask your own question.