title: The risk of suicide after clozapine discontinuation: Cause for concern.
abstract: 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.affiliation: University of Maryland/Sheppard Pratt Psychiatry, Department of Psychiatry, Psychiatry Residency Program, Baltimore, MD USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Patchan
authors.forename: Charles
authors.initials: C
authors.lastname: Richardson
authors.forename: Gopal
authors.initials: G
authors.lastname: Vyas
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kelly
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003024:Clozapine / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012306:Risk; D012559:Schizophrenia / Q000188:drug therapy*; D013405:Suicide; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine