From David Marjot
One of the common symptoms of depression is psychomotor retardation. The patient’s ability to decide on acts of will and carry them out is impaired. If this is severe, the patient may appear comatose. Psychomotor retardation also impairs the ability to plan and carry out acts of self-harm, including suicide.
Before there were specific treatments for depression it was well known that there was a dangerous time when a patient’s psychomotor retardation lifted before their depressive mood. The patient might then be able to plan and carry out acts of self-harm. Early discharge because the patient appeared better was often associated with unexpected suicide.
When electro-convulsive therapy was introduced the same effects were seen. Retardation lifted before the mood, with a greater risk of self-harm at that point in the therapy. The same phenomenon occurred with the old-fashioned or tricyclic antidepressants.
It should come as no surprise that treatment with modern drugs such as the selective serotonin reuptake inhibitors (SSRIs) can have a similar result. I am puzzled that neither the drug companies making SSRIs nor those who later prescribed those antidepressants anticipated the problem.
Advertisement
The risk of precipitating suicidal behaviour at the start of treatment for depression may also apply to psychological or behavioural treatments.
Weybridge, Surrey, UK
