I found Dr. Scott Freeman’s article on suicide prevention (“Suicide assessment: Targeting acute risk factors,” Current Psychiatry, January 2012, p. 52-57) to be bold and courageous. Two of the 6 suicide risk factors he described are related to anxiety symptomatology: panic attacks and psychic anxiety. In the case study, Mr. L was prescribed clonazepam, a benzodiazepine, despite his history of comorbid alcohol abuse. Often, patients with substance abuse have related anxiety disorders—including posttraumatic stress disorder—and management with selective serotonin reuptake inhibitors (SSRIs) is not sufficient.
Because clinicians are hesitant to prescribe benzodiazepines to patients with a substance abuse history, patients often are forced to purchase these medications on the street or feel compelled to relapse to substance abuse in a frantic, albeit misguided, effort to contain their crippling symptoms. Even in inpatient drug rehabilitation settings, benzodiazepines often are not an option because they are not allowed. The “safer” SSRIs may be more dangerous when given to substance abusers in whom a comorbid mood disorder often is missed.
Current Psychiatry has never been shy in addressing the truth or uncomfortable issues in our complex field. Do we have the courage to open this up for dialogue and conversation?
Robert Barris, MD
Attending Psychiatrist
Nassau University Medical Center
East Meadow, NY