@article{ref1,
title="Increased risk of suicide under intrathecal ziconotide treatment? - A warning",
journal="Pain",
year="2011",
author="Maier, Christoph and Gockel, Hans-Helmut and Gruhn, Kai and Krumova, Elena K. and Edel, Marc-Andreas",
volume="152",
number="1",
pages="235-237",
abstract="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) 4weeks 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 15years, developed severe suicidal ideation 2months 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.<p /> <p>Language: en</p>",
language="en",
issn="0304-3959",
doi="10.1016/j.pain.2010.10.007",
url="http://dx.doi.org/10.1016/j.pain.2010.10.007"
}