oddissy4u
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y Nortriptyline is avoided in severely depressed with prior suicidal attems?
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| peekay
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I THINK IT WILL ACT AS STIMULANT AND MAKE THEM AGGRESSIVE AND AT RISK FOR SUICIDE.
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| mjl1717
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peekay is right its called the "switch process"- pt goes from the depressed state to the mania exctement state [seen in manic/depressive illness]
The above is for all efective forms of Rx for depression.
2) also confusion and delirium is common
3)TCA's and MAOs have always been known for acute poisoning or suicide
easily accessable to the patient.
[Goodman and Gillman section III]
*In general we wouldnt want to risk law suit or medical license on this kind of known suicidal behavior.
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| oddissy4u
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wht ab others?
A. Fluoxetine
B. Nortriptyline
C. Sertaline
D. Trazadone
E. Zolipidem
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| mjl1717
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Goodman/Gillman is claiming all effective forms of antidepressant medicine for depression are capable of causing the "switch process"
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| asmi
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I was thinking that SSRI's can be used for such pts with H/o suicide attempts in past . :roll:
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| mjl1717
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The SSRI's may be the lesser of all evils but I dont know if Id risk it.
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| dxtxpx
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I am not sure if this is relative to this topic or not but
whenever prescribing anti-depressents to a pt (previous hx of suicide present or not) , a physician has to be cautious. I remember from step2 kaplan lecture audios: that pt will feel better when put on anti-depressent. he will feel more energy, just enough to carry out a suicide plan. So there is always a risk
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| mjl1717
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yes dxtxpx it is relavent because it is hard to believe that Goodman and Gillman is saying that ALL antidepressants can cause this "switch process"
that you talk of mania, excess energy and a strong probability of suicide!
(severely depressed patients)
Good look out.
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