the risk for suicide in patients with major depression and bipolar disorders is 15% , and the risk is highest in the early stages of the illness . however , suicidal ideation , thoughts , and behavior  collectively termed as suicidality , and suicidal acts have long been linked to antidepressant usage . selective serotonin reuptake inhibitors ( ssris ) , including sertraline , are believed to increase suicidality risks , although controversies do exist regarding the existence of any such real risk . however , despite a diligent search , we could not find any report of sertraline - associated suicidality from india . we report here a case of suicide attempt by a young woman who was on sertraline treatment for 2 years . 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 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 ) 104f , and exaggerated reflexes . 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 . 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 . she was treated with 2l of 5% dextrose normal saline ( dns ) infusion , frusemide 1 ampoule i.v . her vitals improved within 48 h , with pulse rate becoming 76/min and bp 128/78 mm hg . on the 3 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 . there has been a longstanding concern that antidepressants may induce worsening of depression with the emergence of suicidality during the early phases of treatment . ever since the introduction of the ssris , concerns emerged regarding the risk of developing suicidal ideation along with their use . however , controversies mounted as diverging reports supporting and refuting of such concerns continued to pour in.[35 ] in regard to the risk of suicidality , regulatory agencies such as united states  food and drug administration ( us - fda ) or the medicines and healthcare products regulatory agency ( mhra ) ( united kingdom ) responded from time to time to the changing information base . the current position on the matter is that there seems to be no increase in the suicidality risk in sertraline - treated adult patients . however , the latest ( may 2007 ) advisory from us - fda warns against an increased risk of suicidal thinking and behaviors with all antidepressant medications , including sertraline , in young adults aged 18 - 24 years during initial treatment ( generally the first 1 - 2 months ) . as a regulatory mandate by both fda and mrha , the manufacturers of sertraline are required to warn against the dangers of suicidal thoughts and behavior and to include such warning in the package inserts and patient information leaflets . the current index of medical practice , india , mentions under precaution clause for sertraline : monitor for signs of clinical worsening , suicidality and unusual changes in behavior especially during the initial treatment period or when there are dosage adjustments .  in the present case , the 22-year - old woman who was on sertraline treatment for 2 years for major depression took a heavy dose of sertraline with suicidal intent . she revealed that while she was always adherent to the treatment , on several occasions in the past 2 years suicidal thoughts had occupied her mind . she thus clearly demonstrated suicidality with the impulsive consumption of an over dosage of sertraline . it is important to note that contrary to common belief , the suicide attempt in this case occurred after 2 years of treatment with sertraline . to the best of our knowledge , this is the foremost case of sertraline - associated suicidality to be reported from india . patients often describe feelings of hopelessness and despair that may develop after starting treatment with an antidepressant that may lead to suicidality . only careful and frequent monitoring of all patients , particularly children , adolescents , and young adults who are put on long - term treatment with sertraline and other antidepressants , with focus on appearance of suicidal thoughts and behaviors , may detect such tendency , and appropriate measures
a 22-year - old woman who was on sertraline 50 mg oral tablets once daily for 2 years for treatment of major depression took 30 such tablets ( 1500 mg ) in a fit of rage , with a suicidal intent . 
 she presented to the emergency department of a tertiary care hospital with tachycardia , tachypnea , hypertension , tremors , agitation , confusion , vomiting , and hyperthermia . 
 the patient was admitted and treated symptomatically , and sertraline therapy was discontinued . 
 the unwanted effects subsided within 48 h and she recovered uneventfully within 72 h. this case report describes an unsuccessful attempt of suicide with sertraline overdose in a patient on long - term sertraline therapy and underlines the importance of close monitoring of such patients .