The risks of SSRIs and suicidal thoughts • The Medical Republic

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And why researchers also argue for removing olanzapine as a first-line treatment for early psychosis.

Increasing a patient’s SSRI dose too quickly can occasionally improve motivation without changing mood, making them more susceptible to suicide, delegates at the 2023 WONCA conference heard.

Other mental health conference presentations focused on weight gain in early psychosis, brief interventions to improve the well-being of medical students and what almost 20 years of DIAMOND research into depression has yielded.

Here are two of those conversations, in brief.

Case study: sertraline and suicidal ideation

Victorian general practitioner Dr. Naomi Harris gave a detailed case presentation on Friday about a 51-year-old female patient who presented with strong suicidal thoughts and plans.

The patient, previously unknown to Dr. Harris, had been stable on 50 mg of sertraline daily for many years, but had stopped taking the drug himself nine months earlier.

About a fortnight before joining Dr. Harris presented, the patient had a breakdown and was put back on sertraline at a dose of 150 mg per day. She had never had such a high dose before.

“When she presented to me, her main complaints were that her mind was upset, she couldn’t sleep – she described total insomnia – absolutely no appetite, poor concentration, shaking, sweating, crying, anxious and suffering from anxiety. a real sense of impending doom,” said Dr. Harris.

“She lay there all night thinking about suicide… and feeling increasingly sad about the fact that she was spending so much time thinking about suicide and planning what she was going to do.”

Serotonin syndrome was initially considered a differential diagnosis, but did not capture the psychological component of what the patient was experiencing.

After conducting a review of the literature, Dr. Harris found evidence indicating an increased risk of suicide attempts and suicide in older people with major depression who take sertraline.

“Another theory (that I read) was that when a person feels in the grip of severe depression… and he or she is switched to a serotonergic agent, he or she improves so much that he or she is still sad, but no longer unmotivated,” she says. said.

“(They) no longer feel hopeless or helpless and can therefore plan (suicide).”

Dr. Harris told deputies that she had very recently seen another patient with very similar characteristics, making it two cases within 12 months, which prompted her to present to WONCA.

Weight gain in early psychosis

During one of the final sessions at WONCA, medical student Hayden Su presented findings from a study on weight gain in early psychosis, conducted in south-west Sydney.

Mr Su, under the supervision of leading GP Dr Michael Tam, used routinely collected data from 110 patients admitted to Liverpool Hospital’s early psychosis intervention program between 2017 and 2020 to map out typical patterns of weight gain.

Ultimately, he found that patients experienced a 5% increase in body weight after one month, followed by smaller bursts amounting to an overall average increase of 18% after one year.

“The percentage of patients who experienced significant weight gain, defined as more than 7% (of baseline body weight), increased rapidly from 22% in the first month to 61% after five months,” Mr Su told delegates.

“A total of 70% of patients experienced significant weight gain within one year.”

The proportion of patients with a BMI greater than 25 increased from 36% to 71%, while the proportion of people with a BMI greater than 30 increased from 16% to 38%.

The effect was strong regardless of which antipsychotic drugs patients were taking, but people taking olanzapine and clozapine fared the worst.

“The results are likely due to medication naivety, but may also reflect the higher rates of poor lifestyle behavior and socio-economic disadvantage in south-west Sydney,” Mr Su said.

“Olanzapine and clozapine did cause more weight gain in this local context, so their use should be considered very carefully.

“Although clozapine is already limited to treatment-resistant schizophrenia, olanzapine is still sometimes administered as first-line therapy for early psychosis, which clearly needs to change.”

WONCA was held in Sydney from October 26 to 29.

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