Increased risk of suicide under intrathecal ziconotide treatment? - a warning.
Despite some other known psychiatric adverse effects, ziconotide is recommended for intrathecal pain treatment with a good efficacy and safety. Although some hints in previous studies are apparent, a higher suicidality has not been accepted as a treatment risk of ziconotide treatment by the investigators in the former randomized controlled trials so far. We present two cases supporting the suspicion of ziconotide-induced suicidality. Both showed no depressive symptoms at the time of treatment initiation. One patient performed suicide under low-dose (cumulative dosage: 779μg) 4 weeks after the onset of intrathecal ziconotide treatment despite sufficient pain relief. Another female patient with a history of depression, but free of symptoms under antidepressive medication since more than 15 years, developed severe suicidal ideation 2 months after ziconotide treatment (cumulative dosage: about 2900μg) with rapid recovery after drug discontinuation. The patient, who has completed suicide, had earlier given rise to discuss a potential depressive disorder, however, this diagnosis was scrapped, but the second patient had a clear history of depression. These cases substantiate the suspicion of a causal relationship between ziconotide and suicidality even in symptom-free patients with a history of depression. Therefore, a comprehensive psychiatric evaluation is unavoidable before and during ziconotide treatment.
Department of Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany Krankenhaus Vilsbiburg, Bavaria, Germany Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany Department of Psychiatry, Ruhr University Bochum, Germany.
Christoph
C
Maier
Hans-Helmut
HH
Gockel
Kai
K
Gruhn
Elena K
EK
Krumova
Marc-Andreas
MA
Edel
D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D003863:Depression / Q000139:chemically induced* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy; D013405:Suicide; D020960:omega-Conotoxins / Q000009:adverse effects*
D018712:Analgesics, Non-Narcotic; D020960:omega-Conotoxins; C078452:ziconotide