Fluoxetine Reduced Depression, Alcohol, and Marijuana Use in Suicidal Substance Abusers
In one of the only controlled studies of suicidal substance abusers, fluoxetine decreased depression, suicidal ideation, alcohol consumption, and marijuana use, with benefits persisting at one-year follow-up.
Quick Facts
What This Study Found
Studies of suicidal substance abusers are extremely rare because suicidality is typically an exclusion criterion for treatment studies. This review described one of the only double-blind, placebo-controlled studies addressing this population.
The study involved 51 patients with comorbid major depression and alcohol dependence, of whom 39% had attempted suicide in the current episode, 61% had a lifetime attempt, and 90% reported suicidal ideation. Fluoxetine decreased both depressive symptoms (including suicidal ideation) and alcohol consumption, though it did not eliminate either problem entirely.
Secondary analyses revealed additional findings: fluoxetine also significantly reduced marijuana use in a subgroup with cannabis abuse, and the magnitude of improvement was described as "robust." The benefits of fluoxetine for depression and drinking persisted at one-year follow-up. However, cocaine abuse predicted poor outcomes for both depression and alcohol use.
Key Numbers
51 patients in controlled study. 39% current suicide attempt. 61% lifetime attempt. 90% suicidal ideation. Fluoxetine reduced depression, suicidal ideation, alcohol, and marijuana use. Cocaine predicted poor outcome.
How They Did This
Review of one open-label study (12 patients) and one double-blind placebo-controlled study (51 patients) of fluoxetine in suicidal substance abusers, plus secondary analyses and one-year follow-up data.
Why This Research Matters
This is one of the very few studies to include suicidal substance users, who are normally excluded from treatment research. The finding that treating depression with fluoxetine also improved substance use, including marijuana, supports the importance of treating psychiatric comorbidities alongside substance use disorders.
The Bigger Picture
The exclusion of suicidal patients from treatment research has left a critical gap in understanding how to treat one of the highest-risk populations. This study demonstrated that treatment is both possible and effective, though more research is urgently needed.
What This Study Doesn't Tell Us
Only one controlled study with 51 patients. The marijuana finding was a secondary analysis of a subgroup. Fluoxetine reduced but did not eliminate symptoms. The study population was specific (comorbid depression + alcohol dependence) and may not generalize.
Questions This Raises
- ?Would newer antidepressants be more effective?
- ?Does treating depression reduce cannabis use through improved mood or through other mechanisms?
- ?Why does cocaine predict poor outcomes while marijuana does not?
Trust & Context
- Key Stat:
- 90% of patients had suicidal ideation, yet treatment improved multiple outcomes
- Evidence Grade:
- One double-blind, placebo-controlled study with secondary analyses. Important for addressing an underserved population but limited by small sample and secondary analysis design.
- Study Age:
- Published in 2001. Treatment research on suicidal substance abusers remains limited, though this study demonstrated its feasibility.
- Original Title:
- Treating the substance-abusing suicidal patient.
- Published In:
- Annals of the New York Academy of Sciences, 932, 78-90; discussion 91-3 (2001)
- Authors:
- Cornelius, J R, Salloum, I M, Lynch, K, Clark, D B, Mann, J J
- Database ID:
- RTHC-00103
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Did treating depression help with substance use?
Yes. Fluoxetine reduced both depressive symptoms and substance use (alcohol and marijuana), suggesting that treating the underlying depression can improve substance use outcomes.
Why are suicidal patients excluded from research?
Safety concerns and liability issues typically exclude suicidal patients from treatment studies, creating a gap in understanding how to treat this high-risk population.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-00103APA
Cornelius, J R; Salloum, I M; Lynch, K; Clark, D B; Mann, J J. (2001). Treating the substance-abusing suicidal patient.. Annals of the New York Academy of Sciences, 932, 78-90; discussion 91-3.
MLA
Cornelius, J R, et al. "Treating the substance-abusing suicidal patient.." Annals of the New York Academy of Sciences, 2001.
RethinkTHC
RethinkTHC Research Database. "Treating the substance-abusing suicidal patient." RTHC-00103. Retrieved from https://rethinkthc.com/research/cornelius-2001-treating-the-substanceabusing-suicidal
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.