Suicide Prevention: A Unique Opportunity for Pharmacists

According to the Centers for Disease Control and Prevention, the rate of suicide has increased more than 30% in half of the states in the U.S. As a pharmacist and part of many patients’ team of care providers, I and other pharmacists have an important opportunity to help those at risk of suicide.

Many prescription drugs carry a warning of depression or even worse, an increased risk of suicidal ideation. More than  200 medications, including analgesics, anticonvulsants, beta blockers, birth control, proton pump inhibitors, and steroids, to name a few, list these side effects. A recent article published in The Journal of the American Medical Association  found the risk of depression compounded when multiple medications with depression as a side effect are taken together. This is a very concerning dose-response pattern. More than a third of American adults are using medications with this potential, and nearly a quarter of these have suicidal symptoms.

Pharmacists are in a unique role to reduce the risk of suicide within the healthcare system because we’re readily accessible, we talk to patients regularly, and we have access to their medication records. By reviewing their medications, we can infer certain medical conditions that may identify ‘at risk’ patients for suicide, like mental health disorders or chronic pain.

In addition to recognizing risk factors, pharmacists can also notice any changes in how a medication is taken or prescribed. When a patient is prescribed an antidepressant, an important counseling point is to inform the patient that consistent daily use of this medication for at least 4 to 6 weeks is essential for the patient to feel the full relief from their symptoms. Pharmacists are able to monitor adherence to these medications and can start a discussion with the patient if the prescription is late to be refilled. Through the use of motivational interviewing, we can set a nonjudgmental tone throughout the conversation and use open ended questions to identify a potential barrier to adherence. This allows us to follow up with our patients and assess their mental well-being.

At Express Scripts, if a pharmacist believes the patient might be at risk for suicide, or is making any statements indicating self-harm, the most important thing we can do is connect the patient to the right resource. The first thing to do is offer to transfer them to the National Suicide Hotline at 1-800-273-TALK(8255), which is a national network of more than 150 local crisis centers, allowing the Lifeline to provide local resources for that patient. If he or she declines the transfer and is still threatening self-harm, the emergency services in that caller’s city and state should be notified. However, if the patient declines the transfer, and is no longer indicating self-harm, we still recommend they follow up with their provider/counselor and provide them with the TALK line phone number for future use.

While mental health condition is just one factor that may contribute to a person’s risk of suicide, it’s important to recognize the characteristic symptoms of depression. These include:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in virtually all activities of the day
• Significant weight loss (while not dieting) or an increase or decrease in appetite
• A change in sleep pattern, with either too much or too little sleep
• Feelings of worthlessness and self-blame or exaggerated feelings of guilt
• Fatigue or lack of energy nearly every day
• Psychomotor impairment (agitation- restless symptoms, or retardation- reduced physical movements)
• Difficulty with concentration or memory or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt

By educating ourselves, and beginning to better understand mental health, we all can work to prevent suicide. Just by sparking up a conversation, we can provide support to others and guide them to the right resources. Know the risk factors and know the warning signs. Learn more at the National Suicide Prevention Lifeline.