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document
Treating the substance-abusing suicidal patient . Studies concerning the treatment of substance-abusing suicidal patients are scarce despite the frequent presence of suicidal behavior among this population . Indeed , suicidality ( ideation or behavior ) is generally an exclusion criterion for participation in treatment studies of subjects with alcohol or drug abuse . Consequently , to date , little is known about the optimal treatment of this population . The first study involving substance-abusing suicidal patients was an open-label trial conducted in the early 1990s . This study involved 12 patients , all of whom demonstrated recent suicidal ideations and had made a lifetime suicide attempt . The results of that open-label study demonstrated significant within-group improvement in both depressive symptoms ( including suicidal ideations ) and level of drinking . However , substantial residual depressive symptoms and drinking persisted at the end of the trial . Also , because no placebo control group was utilized , the authors of that study could not rule out the possibility that the apparent therapeutic effect from fluoxetine was the result of the placebo effect . To date , only one double-blind , placebo-controlled study of subjects with alcohol or substance abuse has included substantial numbers of suicidal patients . The study involved 51 subjects , of whom 20 ( 39 % ) had made a suicide attempt in the current depressive episode , 31 ( 61 % ) had made a suicide attempt in their lifetime , and 46 ( 90 % ) had reported suicidal ideations in the week before hospitalization . The results of that double-blind , placebo-controlled study suggest that fluoxetine was effective in decreasing but not eliminating both the depressive symptoms ( including suicidal ideations ) and the level of alcohol consumption among a study group of subjects with comorbid major depressive disorder and alcohol dependence , many of whom displayed suicidal ideations . A secondary data analysis from that study suggested that cigarette smoking is also significantly decreased by fluoxetine , but the magnitude of the decrease is limited and few of these patients totally quit smoking with fluoxetine treatment alone . Another secondary data analysis from that study suggested that marijuana smoking was also significantly decreased in a subgroup of subjects who demonstrated cannabis abuse and that the magnitude of this improvement was robust . A third secondary data analysis from that study suggested that cocaine abuse acts as a predictor of poor outcome for both depressive symptoms ( including suicidality ) and level of alcohol use in this population . The results of a 1-year naturalistic follow-up study involving the patients from that study suggest that the benefits of fluoxetine in decreasing depressive symptoms and level of drinking persist 1 year after entering the treatment program . To date , no other double-blind , placebo-controlled studies involving substantial numbers of substance-abusing suicidal patients have been reported to either confirm or refute these findings . Further studies are clearly warranted to evaluate the efficacy of various pharmacotherapeutic agents and various psychotherapies in the treatment of substance-abusing suicidal patients .
6467
Intervention_Educational
open-label study
6468
Intervention_Control
placebo
6469
Intervention_Pharmacological
fluoxetine
6470
Intervention_Control
placebo
6471
Intervention_Control
placebo-controlled
6472
Intervention_Control
placebo-controlled
6473
Intervention_Pharmacological
fluoxetine
6474
Intervention_Pharmacological
fluoxetine
6475
Intervention_Control
placebo-controlled
6476
Outcome_Mental
depressive symptoms and drinking
6477
Outcome_Mental
depressive symptoms ( including suicidal ideations ) and the level of alcohol consumption
6478
Outcome_Mental
cigarette smoking
6479
Outcome_Mental
marijuana smoking
6480
Outcome_Mental
cocaine abuse
6481
Outcome_Mental
depressive symptoms ( including suicidality ) and level of alcohol use
6482
Participant_Condition
substance-abusing suicidal
6483
Participant_Condition
substance-abusing suicidal
6484
Participant_Condition
alcohol or drug abuse
6485
Participant_Condition
substance-abusing suicidal
6486
Participant_Sample-size
12
6487
Participant_Condition
recent suicidal ideations
6488
Participant_Condition
had made a lifetime suicide attempt
6489
Participant_Condition
alcohol or substance abuse
6490
Participant_Sample-size
51
6491
Participant_Sample-size
20
6492
Participant_Condition
suicide attempt in the current depressive episode
6493
Participant_Sample-size
31
6494
Participant_Condition
suicide attempt in their lifetime
6495
Participant_Sample-size
46
6496
Participant_Condition
suicidal ideations
6497
Participant_Condition
substance-abusing suicidal
6498
Participant_Condition
substance-abusing suicidal