Active ingredient ziconotide strengthens thoughts of suicide?

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Researchers at the RUB Clinic Bergmannsheil suspect that the painkiller drug ziconotide increases thoughts of suicide in previously stressed patients. A causal relationship was discovered in two specific cases.

Scientists suspect that the painkiller active ingredient ziconotide is intensifying patients' suicidal thoughts. Ziconotide is produced synthetically and resembles the structure of the poison of the sea snail "Conus magus". The pain reliever was launched on the pharmaceutical market six years ago and should be an effective alternative to morphine. Scientists at the pain clinic “RUB-Klinikum Bergmannsheil” in Bochum speculate that the named active ingredient not only alleviates pain, but can also lead to psychological side effects in patients. It could be observed, for example, that suicidal thoughts seem to be intensified in some patients. The Bochum-based researchers suspect that the person's mood deteriorates as an undesirable effect and at the same time the emotional feeling of “fear” is reduced and impulse control is reduced. If patients are affected by suicidal thoughts beforehand, certain mechanisms can increase triggers for suicide (suicide). The Bochum researchers therefore recommend in the science magazine "PAIN" to closely monitor the patient's psychological state when taking the active ingredient. Doctors should carefully diagnose and closely monitor the patient's psychological situation.

Without contradiction, the active ingredient offers numerous advantages over other strong pain relievers. It does not cause side effects typical of opioids as with antidepressants and does not lead to the development of tolerance. The drug has been marketed in Europe and the American pharmaceutical market since 2004. It offers an alternative in patients for whom opioid drugs are insufficient or have led to undesirable side effects. But for some time now there have been increasing suspicions that the active ingredient ziconotide has side effects that can have undesirable consequences for patients.

Evaluation of studies brought the first indications
In some studies, it was observed that in several cases, patients attempted suicide while taking the drug. However, the authors of the studies at the time were unable to identify any connection with the substance ziconotide. In the specialist magazine "Pain", however, the scientists presented two new cases that substantiate the suspicion that the active ingredient reinforces thoughts of suicide. This is how Prof. Dr. Christoph Maier told the specialist magazine "Pain": "The first case is particularly tragic because a patient who has had pain in the feet for years and numerous unsuccessful attempts at treatment has experienced a significant improvement in his pain for the first time with ziconotide." There were no noticeable side effects. During the therapy, individual examinations were undertaken. An initial slight tendency to depression even decreased at the start of treatment. After about three weeks of taking the medication, the patient still made a balanced and unobtrusive impression on the doctors. After eight weeks of therapy The patient surprisingly committed suicide for everyone.

Causal connection discovered In a second case, a 39-year-old patient was treated with the active ingredient, who has suffered from severe back pain for a good 14 years. Around 20 years ago, the woman developed a depressive episode after pregnancy and attempted suicide at the time. After two months of ziconotide treatment, the patient reported increased suicidal thoughts. In addition, the person concerned reported about other psychological side effects such as hallucinations and confusion as well as a partially occurring memory loss. These conditions also led to two serious car accidents, the patient further reported. The researchers suspect that the accidents were suicidal. As a result, the drug was discontinued by the doctors. After only two weeks, the thought of suicide was gone. The other psychological side effects also decreased after discontinuation. "Both cases support the assumption that there is a causal relationship between ziconotide and suicidal tendency," explained Professor Maier. In the course of the observations, the head of the pain center asked the drug approval authorities and the pharmaceutical manufacturer to check the named adverse effects. "Manufacturer and Regulatory authorities should urgently check this again, "said the expert.

The physician advises his doctor colleagues to carefully examine patients for their psychological condition at the start of therapy and to monitor them sustainably and closely during treatment. The follow-up examinations should also be carried out regardless of the analgesic effect of the preparation. "These cases also underline that an increase in pain therapy in the event of failure of conventional means is not always the right way to go," explained Dr. Maier. "It is often a wrong path, which was also the case at this year's congress of German pain therapists a few weeks ago was pointed out. " However, patients should not stop taking the medicine themselves, but talk to the doctor treating them beforehand about the further course of therapy. (sb)

Also read:
Suicide in depressed people

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