Suicidality and Suicide Attempt in a Young Female on Long-Term Sertraline Treatment
A 22-year-old unmarried woman with a history of major depressive disorder and suicidal ideation presented to the emergency department of a tertiary care hospital with palpitation, hurried breathing, tremors, restlessness, agitation, confusion, and a few bouts of vomiting. In a fit of rage, she consumed 30 tablets of 50 mg sertraline. She was rushed to the hospital and was admitted in the intensive care unit. On admission, she had a pulse rate of 112/min, blood pressure (BP) (lying) 150/90 mm Hg, respiration rate 22/min, temperature (oral) 104°F, and exaggerated reflexes. She was restless and communicative. She had been undergoing treatment for the last 2 years for major depressive disorder in the psychiatry outpatients' department (OPD) of the same hospital, with 50 mg sertraline once daily along with 0.25 mg clonazepam as and when required. She revealed no history of suicidal attempt. On mental status examination, she was conscious, oriented to person but not to time and place, and had poor attention and concentration span. Her speech was incoherent and reduced to whispering. Then, she had an episode of vomiting and, subsequently, had three more episodes after an interval of 2 h. Laboratory investigations such as complete hemogram, serum urea and creatinine, liver function tests, random blood glucose, electrocardiogram, and arterial blood gas analysis were all within normal limits.\nSertraline treatment was suspended. She was treated with 2L of 5% Dextrose Normal Saline (DNS) infusion, frusemide 1 ampoule i.v. inj., ondansetron 1 ampoule (4 mg) i.m. inj., and cold compressions. Her pulse, BP, and temperature were monitored hourly. Her vitals improved within 48 h, with pulse rate becoming 76/min and BP 128/78 mm Hg. She became afebrile also. She started taking food orally. On the 3rd day, the mental status examination showed that her cognition had improved, she was well oriented to time, place, and person; and had a fair level of attention and concentration. Her memory was intact; psychomotor activity was normal; and speech was coherent and goal-directed. The patient was discharged with advice to report for follow-up in the psychiatry OPD. On probing during a predischarge counseling session on the third day, the patient admitted that during the last 2 years she had often been perturbed with suicidal ideation and thoughts, although this was the first time she attempted suicide.