BACKGROUND: Clozapine is a second-generation antipsychotic that has been shown to reduce suicidal ideation and suicidal behaviors in patients with schizophrenia. However, it is underutilized because of its serious side effects. METHODS: We describe 3 patients with a history of suicide ideation and attempts who were successfully treated and maintained in the community without suicidal tendencies while taking clozapine. All 3 patients, men in their 20s, discontinued clozapine because of side effects and subsequently committed suicide. We also review the literature on clozapine's effects on suicidality. RESULTS: In these 3 cases, suicide followed abrupt discontinuation of clozapine or transition to another antipsychotic. CONCLUSIONS: This case series is the first of its kind to document the risk of suicide when clozapine is discontinued. The decision to discontinue clozapine should be made carefully, especially because clozapine is considered the treatment of last resort for patients with treatment-resistant schizophrenia and suicidal ideation. We stress the importance of minimizing the risk of abrupt clozapine discontinuation and recommend further evaluation of suicide ideation and attempts when clozapine is discontinued.
BACKGROUND:Clozapine is a second-generation antipsychotic that has been shown to reduce suicidal ideation and suicidal behaviors in patients with schizophrenia. However, it is underutilized because of its serious side effects. METHODS: We describe 3 patients with a history of suicide ideation and attempts who were successfully treated and maintained in the community without suicidal tendencies while taking clozapine. All 3 patients, men in their 20s, discontinued clozapine because of side effects and subsequently committed suicide. We also review the literature on clozapine's effects on suicidality. RESULTS: In these 3 cases, suicide followed abrupt discontinuation of clozapine or transition to another antipsychotic. CONCLUSIONS: This case series is the first of its kind to document the risk of suicide when clozapine is discontinued. The decision to discontinue clozapine should be made carefully, especially because clozapine is considered the treatment of last resort for patients with treatment-resistant schizophrenia and suicidal ideation. We stress the importance of minimizing the risk of abrupt clozapine discontinuation and recommend further evaluation of suicide ideation and attempts when clozapine is discontinued.
Authors: Deanna L Kelly; Julie Kreyenbuhl; Lisa Dixon; Raymond C Love; Deborah Medoff; Robert R Conley Journal: Schizophr Bull Date: 2006-12-14 Impact factor: 9.306
Authors: Deanna L Kelly; Lisa B Dixon; Julie A Kreyenbuhl; Deborah Medoff; Anthony F Lehman; Raymond C Love; Clayton H Brown; Robert R Conley Journal: J Clin Psychiatry Date: 2006-09 Impact factor: 4.384
Authors: Gunilla Ringbäck Weitoft; Mats Berglund; Eva A Lindström; Mikael Nilsson; Peter Salmi; Måns Rosén Journal: Pharmacoepidemiol Drug Saf Date: 2014-01-17 Impact factor: 2.890
Authors: Robert W Buchanan; Julie Kreyenbuhl; Deanna L Kelly; Jason M Noel; Douglas L Boggs; Bernard A Fischer; Seth Himelhoch; Beverly Fang; Eunice Peterson; Patrick R Aquino; William Keller Journal: Schizophr Bull Date: 2009-12-02 Impact factor: 9.306
Authors: Kathleen Patchan; Gopal Vyas; Ann L Hackman; Marie Mackowick; Charles M Richardson; Raymond C Love; Ikwunga Wonodi; MacKenzie A Sayer; Matthew Glassman; Stephanie Feldman; Deanna L Kelly Journal: Psychiatr Q Date: 2018-03