Nobile Bénédicte, Bonnin Marine, Olié Emilie, Courtet Philippe
Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.
IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
Ann Gen Psychiatry. 2022 Jul 1;21(1):24. doi: 10.1186/s12991-022-00401-6.
The opioid tramadol is used as analgesic drug, and more recently was also proposed for the management of major depressive disorder. However, growing evidence suggests a link between opioid system dysfunction and suicidal behaviors, raising the question of tramadol use in view of the high addictive and suicidal risk. Here, we present the case of a young adult woman with multiple suicide attempts related to tramadol addiction.
A 25-year-old woman was admitted for suicide attempt by phlebotomy in the Department of Psychiatric Emergency and Acute Care, Montpellier (France), in March 2020. The suicide attempt occurred 3 days after an abrupt tramadol withdrawal. In 2018, due to spinal disc herniation, she had a first prescription of tramadol to which she became addicted. The patient described an effect on psychological pain and suicidal ideation. However, she had to increase tramadol dose to obtain the desired effects, and for several months her intake was 2 000 mg per day. When she could not obtain tramadol any longer, suicidal ideation and psychological pain increased, leading to the suicide attempt. At the time of a worldwide opioid crisis that contributes to increasing suicidal behaviors, this case raises questions about tramadol prescription (often considered to be less addictive and with lower abuse potential) to individuals at risk of suicide.
阿片类药物曲马多用作镇痛药，最近也被提议用于治疗重度抑郁症。然而，越来越多的证据表明阿片类系统功能障碍与自杀行为之间存在联系，鉴于曲马多具有高度成瘾性和自杀风险，这引发了关于使用曲马多的问题。在此，我们报告一例与曲马多成瘾相关的多次自杀未遂的年轻成年女性病例。
一名25岁女性于2020年3月在法国蒙彼利埃的精神科急诊与急性护理部因割腕自杀未遂入院。自杀未遂发生在突然停用曲马多3天后。2018年，由于腰椎间盘突出症，她首次开具了曲马多处方并对其成瘾。患者描述曲马多对心理疼痛和自杀意念有影响。然而，她不得不增加曲马多剂量以获得预期效果，几个月来她每天的摄入量为2000毫克。当她无法再获得曲马多时，自杀意念和心理疼痛加剧，导致了这次自杀未遂。在全球阿片类药物危机导致自杀行为增加的背景下，该病例引发了对于向有自杀风险的个体开具曲马多处方（通常被认为成瘾性较低且滥用潜力较小）的质疑。
