More Fallout From Managed Care

The issues surrounding antidepressants and suicidality are leading to confusion among parents, patients, and providers. One factor that needs to be looked at is the effect of managed care on increased suicidality.

When I was trained 40 years ago, we were made aware of the increased suicidality risk associated with the available antidepressants that started on day 3 and continued through day 14. Thus, patients at risk were kept in the hospital during that period. Now that patients are usually kept in the hospital for about four days, the risk may be increased as patients are discharged at the peak of any suicidal ideation, when energy increases before affect improves.

I doubt managed care will suddenly see the light and allow more hospital time to protect patients; therefore, we psychiatrists, as well as parents and patients, need to be aware of this risk and provide protective supervision for potentially vulnerable persons.