24 overlapping symptoms: J. Biederman, S. V. Faraone, E. Mick, J. Wozniack, L. Chen, C. Ouellette, A. Marrs, P. Moore, J. Garcia, D. Mennin, and E. Lelon, “Attention Deficit Hyperactivity Disorder and Juvenile Mania: An Overlooked Comorbidity?” Journal of the American Academy of Child and Adolescent Psychiatry, 35 (1996): 997–1008; J. Biederman, R. Russell, J. Soriano, J. Wozniak, and S. V. Faraone, “Clinical Features of Children with Both ADHD and Mania: Does Ascertainment Source Make a Difference?” Journal of Affective Disorders, 51 (1998): 101–112; G. A. Carlson, “Mania and ADHD: Comorbidity or Confusion,” Journal of Affective Disorders, 51 (1998): 177–187; B. Geller, M. Williams, B. Zimerman, J. Frazier, L. Beringer, and K. L. Warner, “Prepubertal and Early Adolescent Bipolarity Differentiate from ADHD by Manic Symptoms, Grandiose Delusions, Ultra-Rapid or Ultradian Cycling,” Journal of Affective Disorders, 51 (1998): 81–91.
25 Their pre-illness: D. Quackenbush, S. Kutcher, H. Robertson, C. Boulos, and P. Chaban, “Premorbid and Postmorbid School Functioning in Bipolar Adolescents: Description and Suggested Academic Interventions,” Canadian Journal of Psychiatry, 41 (1996): 16–22; S. Kutcher, H. A. Robertson, and D. Bird, “Premorbid Functioning in Adolescent Onset Bipolar I Disorder: A Preliminary Report from an Ongoing Study,” Journal of Affective Disorders, 51 (1998): 137–144.
26 controversial and unresolved: F. Rouillon, R. Phillips, E. Serrurier, E. Ansart, and M. J. Gerard, “Prophylactic Efficacy of Maprotiline on Relapses of Unipolar Depression.” L ‘Encéphale, 15 (1989): 527–534; M. H. Teicher, C. Glod, and J. O. Cole, “Emergence of Intense Suicidal Preoccupation During Fluoxetine Treatment,” American Journal of Psychiatry, 147 (1990): 207–210; A. C. Power and P. J. Cowen, “Fluoxetine and Suicidal Behaviour: Some Clinical and Theoretical Aspects of a Controversy,” British Journal of Psychiatry, 161 (1992): 735–741; M. H. Teicher, C. A. Glod, and J. O. Cole, “Antidepressant Drugs and the Emergence of Suicidal Tendencies,” Drug Safety, 8 (1993): 186–212; D. Healy, “The Fluoxetine and Suicide Controversy: A Review of the Evidence,” CNS Drugs, 1 (1994): 223–231.
27 antidepressants do not increase: S. A. Montgomery and R. M. Pinder, “Do Some Antidepressants Promote Suicide?” Psychopharmacology, 92 (1987): 265–266; C. M. Beasley, B. E. Dornseif, J. C. Bosomworth, M. E. Sayler, A. H. Rampey, J. H. Heiligenstein, V. L. Thompson, D. J. Murphy, and D. N. Masica, “Fluoxetine and Suicide: A Meta-Analysis of Controlled Trials of Treatment for Depression,” British Medical Journal, 303 (1991): 685–692; P. N. Jenner, “Paroxetine: An Overview of Dosage, Tolerability, and Safety,” International Clinical Psychopharmacology, 6 (Suppl. 4) (1992): 69–80; G. D. Tollefson, J. Fawcett, G. Winokur, C. M. Beasley, J. H. Potvin, D. E. Faries, A. H. Rampey, and M. E. Sayler, “Evaluation of Suicidality During Pharmacologic Treatment of Mood and Nonmood Disorders,” Annals of Clinical Psychiatry, 5 (1993): 209–224; S. Kasper, S. Schindler, and A. Neumeister, “Risk of Suicide in Depression and Its Implication for Psychopharmacological Treatment,” International Clinical Psychopharmacology, 11 (1996): 71–79; J. F. Wernicke, M. E. Sayler, S. C. Koke, D. K. Pearson, and G. D. Tollefson, “Fluoxetine and Concomitant Centrally Acting Medication Use During Clinical Trials of Depression: The Absence of an Effect Related to Agitation and Suicidal Behavior,” Depression and Anxiety, 6 (1997): 31–39; A. C. Leon, M. B. Keller, M. G. Warshaw, T. I. Mueller, D. A. Solomon, W. Coryell, and J. Endicott, “Prospective Study of Fluoxetine Treatment and Suicidal Behavior in Affectively Ill Subjects,” American Journal of Psychiatry, 156 (1999): 195–201.
28 “possibility of a suicide attempt”: Physicians’ Desk Reference (Montvale, N.J.: Medical Economics Company, 1996), p. 921.
29 The newer SSRIs: H.-J. Möller and E. M. Steinmeyer, “Are Serotonergic Reuptake Inhibitors More Potent in Reducing Suicidality?: An Empircal Study on Paroxetine,” European Neuropsychopharmacology, 4 (1994): 55–59; D. C. Steffens, K. R. R. Krishnan, and M. J. Helms, “Are SSRIs Better than TCAs? Comparison of SSRIs and TCAs: A Meta-Analysis,” Depression and Anxiety, 6 (1997): 10–18; O. Benkert, M. Burkart, and H. Wetzel, “Existing Therapies with Newer Antidepressants—Their Strengths and Weaknesses,” in M. Briley and S. A. Montgomery, eds., Antidepressant Therapy at the Dawn of the Third Millennium (St. Louis: Mosby, 1998), pp. 213–230; B. Müller-Oerlinghausen and A. Berghöfer, “Antidepressants and Suicidal Risk,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 94–99; Treatment of Depression—Newer Pharmacotherapies, HCPR Publication No. 99-E014 (Rockville, Md.: Agency for Health Care Policy and Research, 1999).
30 used to good effect: J. R. Cornelius, I. M. Salloum, M. D. Cornelius, J. M. Perel, M. E. Thase, J. G. Ehler, and J. J. Mann, “Fluoxetine Trial in Suicidal Depressed Alcoholics,” Psychopharmacology Bulletin, 29 (1993): 195–199; J. R. Cornelius, I. M. Salloum, J. G. Ehler, P. J. Jarrett, M. D. Cornelius, J. M. Perel, M. E. Thase, and A. Black, “Fluoxetine in Depressed Alcoholics: A Double-Blind, Placebo-Controlled Trial,” Archives of General Psychiatry, 54 (1997): 700–705; I. M. Salloum, J. R. Cornelius, M. E. Thase, D. C. Daley, L. Kirisci, and C. Spotts, “Naltrexone Utility in Depressed Alcoholics,” Psychopharmacology Bulletin, 34 (1998): 111–115.
31 in British women: D. Gunnell, H. Wehner, and S. Frankel, “Sex Differences in Suicide Trends in England and Wales,” Lancet, 353 (1999): 556–557.
32 “Substance P”: M. S. Kramer, N. Cutler, J. Feighner, R. Shrivastava, J. Carman, J. J. Sramek, S. A. Reines, G. Liu, D. Snavely, E. Wyatt-Knowles, J. J. Hale, S. G. Mills, M. MacCoss, C. J. Swain, T. Harrison, R. G. Hill, F. Hefti, E. M. Scolnick, M. A. Cascieri, G. G. Chicchi, S. Sadowski, A. R. Williams, L. Hewson, D. Smith, E. J. Carlson, R. J. Hargreaves, and N. M. J. Rupniak, “Distinct Mechanism for Antidepressant Activity by Blockade of Central Substance P Receptors,” Science, 281 (1998): 1640–1644.
33 Omega-3 fatty acids: A. L. Stoll, E. Severus, M. P. Freeman, S. Rueter, H. A. Zboyan, E. Diamond, K. K. Cress, and L. B. Marangell, “Omega-3 Fatty Acids in Bipolar Disorder: A Double-Blind Placebo-Conrolled Trial,” Archives of General Psychiatry, 56 (1999): 407–412.
34 A seventeen-year epidemiological study: T. Hirayama, Life-Style and Mortality: A Large Census-Based Cohort Study in Japan (Basel: Karger, 1990).
35 there have been reports: N. Praschak-Rieder, A. Neumeister, B. Hesselmann, M. Willeit, C. Barnas, and S. Kasper, “Suicidal Tendencies as a Complication of Light Therapy for Seasonal Affective Disorder: A Report of Three Cases,” Journal of Clinical Psychiatry, 58 (1997): 389–392; Y. Meesters and C. A. J. van Houwelinger, “Rapid Mood Swings After Unmonitored Light Exposure,” American Journal of Psychiatry, 155 (1998): 306; A. M. O’Breasail and S. Argouarch, “Hypomania and St. John’s Wort,” Canadian Journal of Psychiatry, 43 (1998): 746–747. For an excellent overview of St. John’s wort, see N. Rosenthal, St. John’s Wort (New York: HarperCollins, 1998).
36 they can cause akathisia: R. DeAlarcon and M. W. P. Carney, “Severe Depressive Mood Changes Following Slow-Release Intramuscular Fluphenazine Injection,” British Medical Journal, 3 (1969): 564–567; D. E. Raskin, “Akathisia: A Side-Effect to Be Remembered,” American Journal of Psychiatry, 129 (1972): 121–123; K. Shear, A. Frances, and P. Weiden, “Suicide Associated with Akathisia and Depot Fluphenazine Treatment,” Journal of Clinical Psychopharmacology, 3 (1983): 235–236; R. E. Drake and J. Ehrlich, “Suicide Attempts Associated with Akathisia,” American Journal of Psychiatry, 142 (1985): 499–501; R. E. Drake, S. J. Bartels, and W. C. Torrey, “Suicide in Schizophrenia: Clinical Approaches,” in R. Williams and J. T. Dalby, eds., Depression in Schizophrenics (New York: Plenum Press, 1989), pp. 171–183; P. Sachdev, Akathisia and Restless Legs (Cambridge, England: Cambridge University Press, 1995).
37 But used carefully: H. Warnes, “Suicide in Schizophrenics,” Diseases of the Nervous System, 29 (Suppl. 5) (1968): 35–40; D. A. W. Johnson, G. Pasterski, J. M. Ludlow, K. Street, and R. D. W. Taylor, “The Discontinuance of Maintenance Neuroleptic Therapy in Chronic Schizophrenic Patients: Drug and Social Consequences,” Acta Psychiatrica S
candinavica, 67 (1983): 339–352; T. J. Taiminen, “Effect of Psychopharmacotherapy on Suicide Risk in Psychiatric Inpatients,” Acta Psychiatrica Scandinavica, 87 (1993): 45–47; H. Y. Meltzer and G. Okayli, “Reduction of Suicidality During Clozapine Treatment of Neuroleptic-Resistant Schizophrenia: Impact on Risk-Benefit Assessment,” American Journal of Psychiatry, 152 (1995): 183–190; T. P. Hogan and A. G. Awad, “Pharmacotherapy and Suicide Risk in Schizophrenia,” Canadian Journal of Psychiatry, 28 (1983): 277–281; A. M. Walker, L. L. Lanza, F. Arellano, and K. J. Rothman, “Mortality in Current and Former Users of Clozapine,” Epidemiology, 8 (1997): 671–677; D. D. Palmer, I. D. Henter, and R. J. Wyatt, “Do Antipsychotic Medications Decrease the Risk of Suicide in Patients with Schizophrenia?” Journal of Clinical Psychiatry, 60 (suppl. 2) (1999): 100–103.
38 Electroconvulsive therapy: M. T. Tsuang, G. M. Dempsey, and J. A. Fleming, “Can ECT Prevent Premature Death and Suicide in ‘Schizoaffective’ Patients?” Journal of Affective Disorders, 1 (1979): 167–171; B. L. Tanney, “Electroconvulsive Therapy and Suicide,” Suicide and Life-Threatening Behavior, 16 (1986): 199–222; D. W. Black, G. Winokur, E. Mohandoss, R. F. Woolson, and A. Nasrallah, “Does Treatment Influence Mortality in Depressives? A Follow-up of 1076 Patients with Major Affective Disorders,” Annals of Clinical Psychiatry, 1 (1989): 165–173; American Psychiatric Association Task Force on ECT, The Practice of ECT: Recommendations for Treatment, Training and Privileging (Washington, D.C.: American Psychiatric Press, 1990); E. T. Isometsä, M. M. Henriksson, M. E. Heikkinen, et al., “Completed Suicide and Recent Electroconvulsive Therapy in Finland,” Convulsive Therapy, 12 (1996): 152–155; J. Prudic and H. A. Sackeim, “Electroconvulsive Therapy and Suicide Risk,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 104–110.
39 “The narcissistic ponderings”: J. M. Himmelhoch, “Lest Treatment Abet Suicide,” Journal of Clinical Psychiatry, 48 (1987): 44–54.
40 A new, noninvasive: M. S. George, E. M. Wassermann, W. A. Williams, A. Callahan, T. A. Ketter, P. Basser, M. Hallett, and R. M. Post, “Daily Repetitive Transcranial Magnetic Stimulation (rTMS) Improves Mood in Depression,” Neuroreport, 6 (1995): 1853–1856; A. Pascual-Leone, B. Rubio, F. Pallardo, and M. D. Catala, “Beneficial Effect of Rapid-Rate Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Drug-Resistant Depression,” Lancet, 348 (1996): 233–237; R. H. Belmaker, N. Grisaru, D. Ben-Sharar, and E. Klein, “The Effects of TMS on Animal Modes of Depression, Beta-Adrenergic Receptors and Brain Monoamines,” CNS Spectrums: International Journal of Neuropsychiatric Medicine, 2 (1997): 26–30; M. S. George, E. M. Wassermann, T. A. Kimbrell, J. J. Little, W. E. Williams, A. L. Danielson, B. D. Greenberg, M. Hallett, and R. M. Post, “Mood Improvement Following Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in Patients with Depression: A Placebo-Controlled Crossover Trial,” American Journal of Psychiatry, 154 (1997): 1752–1756; M. S. George, S. H. Lisanby, and H. A. Sackiem, “Transcranial Magnetic Stimulation: Applications in Neuropsychiatry,” Archives of General Psychiatry, 56 (1999); 300–311.
41 series of studies: G. L. Klerman, A. De Mascio, M. M. Weissman, B. A. Prusoff, and E. S. Paykel, “Treatment of Depression by Drugs and Psychotherapy,” American Journal of Psychiatry, 131 (1974): 186–191; A. S. Friedman, “Interaction of Drug Therapy with Marital Therapy in Depressed Patients,” Archives of General Psychiatry, 32 (1975): 619–637; M. M. Weissman, “The Psychological Treatment of Depression: Evidence for the Efficacy of Psychotherapy Alone, in Comparison with, and in Combination with Pharmacotherapy,” Archives of General Psychiatry, 36 (1979): 1261–1269; M. M. Weissman, B. A. Prusoff, A. De Mascio, C. Neu, M. Goklaney, and G. L. Klerman, “The Efficacy of Drugs and Psychotherapy in the Treatment of Acute Depressive Episodes,” American Journal of Psychiatry, 136 (1979): 555–558; D. S. Janowsky and R. J. Neborsky, “Hypothesized Common Mechanism in the Psychotherapy and Psychopharmacology of Depression,” Psychiatric Annals, 10 (1980): 356–361; I. M. Blackburn, S. Bishop, A. I. M. Glen, L. J. Whalley, and J. E. Christie, “The Efficacy of Cognitive Therapy and Pharmacotherapy, Each Alone and in Combination,” British Journal of Psychiatry, 139 (1981): 181–189; G. E. Murphy, A. D. Simons, R. D. Wetzel, and P. J. Lustman, “Cognitive Therapy and Pharmacotherapy: Singly and Together in the Treatment of Depression,” Archives of General Psychiatry, 41 (1984): 33–41; E. Frank and D. J. Kupfer, “Maintenance Treatment of Recurrent Unipolar Depression: Pharmacology and Psychotherapy,” in D. Demali and G. Racagni, eds., Chronic Treatments in Neuropsychiatry (New York: Raven Press, 1985), pp. 139–151.
42 convincing recent work: S. Cochran, “Preventing Medical Noncompliance in the Outpatient Treatment of Bipolar Affective Disorders,” Journal of Consulting and Clinical Psychology, 52 (1984): 873–878; K. Jamison, “Manic-Depressive Illness: The Overlooked Need for Psychotherapy,” in B. Beitman and G. Klerman, eds., Integrating Pharmacotherapy and Psychotherapy (Washington, D.C.: American Psychiatric Association, 1991), pp. 409–420; E. Frank, D. Kupfer, C. Ehlers, T. Monk, C. Cornes, S. Carter, and D. Frankel, “Interpersonal and Social Rhythm Therapy for Bipolar Disorder: Integrating Interpersonal and Behavioral Approaches,” Behavior Therapist, 17 (1994): 143–149; A. F. Lehman, “Vocational Rehabilitation for Schizophrenia,” Schizophrenia Bulletin, 21 (1995): 645–656; J. Scott, “Psychotherapy for Bipolar Disorder,” British Journal of Psychiatry, 167 (1995): 581–588; M. Basco and A. J. Rush, Cognitive-Behavioral Therapy for Bipolar Disorder (New York: Guilford, 1996); I. R. H. Falloon, J. H. Coverdale, and C. Brooker, “Psychosocial Interventions in Schizophrenia: A Review,” International Journal of Mental Health, 25 (1996): 3–23; D. Miklowitz, “Psychotherapy in Combination with Drug Treatment for Bipolar Disorder,” Journal of Clinical Psychopharmacology, 16 (Suppl.) (1996): 56–66; D. Miklowitz, E. Frank, and E. George, “New Psychosocial Treatments for the Outpatient Management of Bipolar Disorder,” Psychopharmacology Bulletin, 32 (1996): 613–621; D. L. Penn and K. T. Mueser, “Research Update on the Psychosocial Treatment of Schizophrenia,” American Journal of Psychiatry, 153 (1996): 607–617; E. Frank, S. Hlastala, P. Houck, X. M. Tu, T. Monk, A. Mallinger, and D. Kupfer, “Inducing Lifestyle Regularity in Recovering Bipolar Disorder Patients: Results from the Maintenance Therapies in Bipolar Disorder Protocol,” Biological Psychiatry, 41 (1997): 1165–1173; J. M. Harkavy-Friedman and E. A. Nelson, “Assessment and Intervention for the Suicidal Patient with Schizophrenia,” Psychiatric Quarterly, 68 (1997): 361–375; I. R. H. Falloon, R. Roncone, U. Malm, and J. H. Coverdale, “Effective and Efficient Treatment Strategies to Enhance Recovery from Schizophrenia: How Much Longer Will People Have to Wait Before We Provide Them?” Psychiatric Rehabilitation Skills, 2 (1998): 107–127.
43 “Why do we now give psychiatrists”: T. S. Szasz, “A Moral View on Suicide,” in D. Jacobs and H. N. Brown, eds., Suicide: Understanding and Responding (Madison, Conn.: International Universities Press, 1989), pp. 437–447, pp. 442, 446.
44 The legal complaint: State of New York, County of Onondaga, Hilde Klein v. Thomas Szasz, M.D., August 2, 1994; justice presiding: Hon. Parker J. Stone, J.S.C., Index No. 92-660, RJI No. 33-92-640.
45 “capacity to hear out carefully”: N. H. Cassem, “Treating the Person Confronting Death,” in A. M. Nicholi, ed., Harvard Guide to Modern Psychiatry (Cambridge, Mass.: Belknap Press of Harvard University Press, 1978), pp. 579–606, p. 595.
46 “Because the doctors cared”: M. Coate, Beyond All Reason (London: Constable, 1964), p. 214.
47 twenty controlled clinical trials: P. M. Salkovskis, C. Atha, and D. Storer, “Cognitive-Behavioral Problem Solving in the Treatment of Patients Who Repeatedly Attempt Suicide: A Controlled Trial,” British Journal of Psychiatry, 157 (1990): 871–876; M. M. Linehan, H. E. Armstrong, A. Suarez, D. Allmon, and H. L. Heard, “Cognitive Behavioral Treatment of Chronically Parasuicidal Borderline Patients,” Archives of General Psychiatry, 48 (1991): 1060–1064; M. M. Linehan, H. L. Heard, and H. E. Armstrong, “Naturalistic Follow-up of a B
ehavioral Treatment for Chronically Parasuicidal Borderline Patients,” Archives of General Psychiatry, 50 (1993): 971–974; C. Van Heeringen, S. Jannes, W. Buylaert, H. Henderick, D. De Bacquer, and J. van Remoortel, “The Management of Non-Compliance with Referral to Outpatient After-Care Among Attempted Suicide Patients: A Controlled Intervention Study,” Psychological Medicine, 25 (1995): 963–970; M. M. Linehan, “Behavioral Treatments of Suicidal Behaviors: Definitional Obfuscation and Treatment Outcomes,” Annals of the New York Academy of Sciences, 836 (1997): 302–328; R. van der Sande, E. Buskens, E. Allart, Y. van der Graaf, and H. van Engeland, “Psychosocial Intervention Following Suicide Attempt: A Systematic Review of Treatment Interventions,” Acta Psychiatrica Scandinavica, 96 (1997): 43–50; K. Hawton, E. Arensman, E. Townsend, S. Bremner, E. Feldman, R. Goldney, D. Gunnell, P. Hazell, K. van Heeringen, A. House, D. Owens, I. Sakinofsky, and L. Träskman-Bendz, “Deliberate Self-Harm: Systematic Review of Efficacy of Psychosocial and Pharmacological Treatments in Preventing Repetition,” British Medical Journal, 317 (1998): 441–447. Preliminary data from the University of Pittsburgh suggest that structured psychotherapy in conjunction with sleep and other forms of biological regulation may reduce active suicidal ideation in bipolar patients (Ellen Frank, Ph.D., personal communication, April 15, 1999).
48 situations of interpersonal conflict: J. Birtchnell, “Some Familial and Clinical Characteristics of Female Suicidal Psychiatric Patients,” British Journal of Psychiatry, 138 (1981): 381–390; K. Hawton, D. Cole, J. O’Grady, and M. Osborn, “Motivational Aspects of Deliberate Self-Poisoning in Adolescents,” British Journal of Psychiatry, 141 (1982): 286–291; K. Hawton and J. Catalan, Attempted Suicide: A Practical Guide to Its Nature and Management (Oxford: Oxford University Press, 1982); D. James and K. Hawton, “Explanations and Attitudes in Self-Poisoners and Significant Others,” British Journal of Psychiatry, 146 (1985): 481–485; B. C. McLeavey, R. J. Daly, J. W. Ludgate, and C. M. Murray, “Interpersonal Problem-Solving Skills Training in the Treatment of Self-Poisoning Patients,” Suicide and Life-Threatening Behavior, 24 (1994): 382–394.
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