Citation

Marsalek M. Ceska Slov. Psychiatr. 1998; 94(5): 272-281.

Copyright

(Copyright © 1998, Ceska Lekarska Spolecnost Jana Evangelisty Purkyne)

DOI

unavailable

PMID

unavailable

Abstract

Suicidal ideation and behavior can sometimes emerge in persons with obsessive or panic features who take antidepressants or neuroleptics. Typical for such state is rapid development, impulsive and/or obsessive characteristic of suicidal ideation, an independence of the course of depression, severe tension and anxiety, an intense violence of suicidal fantasies and attempts, and their prompt disappearance after the discontinuation of the antidepressant. The symptom occurs more frequently after a rapid dose increase or the use of high dosage of antidepressants or neuroleptics. A combination of selective serotonin reuptake inhibitors (SSRI) and neuroleptics is not recommended. There is clinical evidence of the link between akathisia and suicidal tendencies. The relationship between the akathisia and the jitteriness syndrome is discussed. There have been proposed the following mechanisms for the pathophysiology of the symptom: 1. the direct serotonergic influence, 2. the direct noradrenergic influence, 3. the indirect serotonergic or noradrenergic influence due to dopamine inhibition, resulting in the development of akathisia. The reduction or the discontinuation of antidepressants or neuroleptics, and the treatment with benzodiazepines or beta blockers should be recommended when the drug-induced suicidal tendencies are recognised.

Language: cs

Keywords

akathisia; Akathisia; alprazolam; amitriptyline; amoxapine; antidepressant agent; Antidepressants; article; benzodiazepine derivative; beta adrenergic receptor blocking agent; depression; desipramine; drug efficacy; Drug-induced suicidal tendencies; dysthymia; fluoxetine; haloperidol; human; imipramine; Jitteriness syndrome; maprotiline; mianserin; nervousness; neuroleptic agent; Neuroleptics; nortriptyline; Obsession; Panic; paroxetine; risk assessment; risk management; schizophrenia; serotonin uptake inhibitor; sertraline; suicidal behavior; trazodone; tricyclic antidepressant agent