Suicide attempt blamed on improper med management
A MAN WITH OBSESSIVE-COMPULSIVE DISORDER was prescribed fluoxetine by his psychiatrist as part of treatment. After several years, the psychiatrist discontinued the medication; the patient subsequently developed selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome, including depression and suicidal ideation. The patient tried, unsuccessfully, to kill himself with a shotgun and ended up facing criminal charges of reckless endangerment.
The patient was transferred to the care of another psychiatrist, who prescribed higher doses of fluoxetine. The suicidal ideation stopped, but the patient complained of ongoing, disabling depression and distress related to his suicide attempt.
PLAINTIFF’S CLAIM The doctor failed to manage the patient’s medication properly. Discontinuing fluoxetine is known to cause the symptoms the patient experienced.
THE DEFENSE The plaintiff had told the first psychiatrist that he wanted to discontinue fluoxetine and had failed to report any concerns related to stopping the drug. SSRI discontinuation syndrome is rare, and the symptoms are difficult to detect.
VERDICT $911,000 New York verdict.
COMMENT Although I would quibble with the label discontinuation syndrome (sounds more like recurrent major depressive disorder), it’s very important to monitor patients carefully when starting treatment with an antidepressant, during changes in therapy, and after discontinuing a drug.