Does the use of Oxetol by my 23-year-old brother for psychiatric illness increase his suicidal tendencies?

Question

Hi doctor

In last year, my 23-year-old brother was diagnosed with severe depression. He experienced symptoms such as thought broadcasting, suspicion, fearfulness, and a feeling of being followed by someone. He also believed that his mobile phone was hacked, and that the world could hear his thoughts, making him feel guilty for past mistakes. These issues arose when he was living alone in a flat. We also had some problems with relatives related to property matters after our father's passing, which he happened to disclose to a person he trusted but later regretted for no apparent reason. The initial doctor prescribed Oleanz 2.5, Quitipin 25 mg, Lonazep 0.25 mg, Dolo 650, and Kefpod CV for fever. However, after a week of taking these medicines, he attempted suicide and displayed self-harming behavior. We consulted another doctor who prescribed Nexito, Oleanz, and Pacitane. Although he calmed down initially and seemed to be back to normal, after a month, he started experiencing irritability. Another doctor determined that the irritability was due to Nexito and stopped that medication while adding lithium. This change helped him calm down again. However, due to Oleanz 20, my brother's SGPT, SGOT, and cholesterol levels increased. The doctor refused to decrease the dose, suggesting that the elevated levels might be due to hepatitis. We consulted a gastroenterologist who conducted various tests, including a 24-hour urine test, which came back positive with no issues. The gastroenterologist and psychiatrist agreed to stop Oleanz. Seeking another opinion, we consulted a different psychiatrist to discontinue Oleanz. By this time, my brother had been on Oleanz and lithium for seven months, with Pacitane continued as well. During a blood test, we found that the liver function was not improving, and the doctor stopped lithium (which had been taken for six months at that point). All medications were then discontinued, and Oxetol 150 mg was prescribed for five days, followed by 300 mg for 20 days. If there are any sleeping issues, Ativan 1 mg can be taken. This medication was started yesterday. Additionally, my brother is taking Rosuvas 10 to lower cholesterol and Udiliv 300 for liver support. Blood report findings include: total cholesterol 224, HDL-35, non-HDL-189, LDL-154, VLDL-31.2, total cholesterol/ HDL-C ratio 6.4, LDL-C/ HDL-C ratio 4.4, AST 50 U/L, ALT 110 U/L.

Regarding the medication, I read an article stating that Oxetol is not recommended for individuals who have had suicidal thoughts and is primarily used for seizures. Currently, my brother is doing well, working remotely for a company. However, he experiences a brief period of low mood between 6 to 7 PM, lasting around 15 to 30 minutes, during which he is unable to handle negative triggers. Apart from this, he is mostly back to normal. Sometimes, he mentions wanting to leave and stay with his friends. I would like to know if we are on the right track with the medication. Is it safe for his liver? Are there any potential medication interactions? We are concerned about the possibility of suicidal tendencies due to the Oxetol medication, as some reviews suggest it may lead to such thoughts.

Thank you.

Answer 1

Hello,

I am glad you chose icliniq for your medical-related queries.

I understand your concern.

First of all, he does not have depression, but based on the mentioned symptoms, he is experiencing psychosis and guilt. Due to his guilt, he has suicidal thoughts. In his case, it is advisable to continue with lithium instead of Oxetol (Oxcarbazepine), as lithium effectively controls suicidal thoughts. A dosage of 400 mg of lithium is safe and does not have any negative effects on the liver or kidney. Oleanz (a combination of Fluoxetine and Olanzapine) is responsible for metabolic side effects, so it is good that you have already stopped it. For better control of psychotic symptoms, it is recommended to start an atypical antipsychotic medication such as Risperidone, Cariprazine, or Blonanserin. If he is currently doing well, you can continue with Oxetol. While some articles mention an increased risk of suicidality, it is very rare and depends on the symptoms of the illness. Therefore, there is no need to worry and he can continue the medication as he is improving and functioning. If he does not show improvement or if his symptoms worsen, you can consider the options I have suggested. Consult your specialist doctor, discuss with them, and take the medicines with their consent. Additionally, if possible, ask his friends to observe and note down any changes in his behavior. Encourage him to engage in daily exercise for at least 45 minutes and to abstain from alcohol if he consumes it.Does he have any family history of psychiatric illness? Has he experienced a similar condition in the past? Is he currently under any stress or tension? Are there any suspicious or fearful symptoms he is currently experiencing? Is he exhibiting any mood symptoms, rapid mood swings, or irritability?

You can always come back and reach me at icliniq.com.

Thank you for consulting me.

Answer 2

Hello,

Welcome back to icliniq.com

As you mentioned that his brother and father have some psychiatric issues, he requires long-term treatment. Once he shows complete improvement on medication, the dosage should be gradually reduced. It is completely curable if it is the first or second episode, which occurs in 25 percent of cases. Otherwise, a lower dose of medication needs to be continued for a long time. In his case, a family history of psychiatric illness favors long-term treatment as there may be a genetic component involved. In any psychiatric illness, there is always a chance of relapse in the future, so it is important to watch for certain symptoms and specific stress factors. Right now, as you suggested, since there is no past history, we consider this as the first episode, and therefore, we need to continue the medication for two years. There is no need to worry about suicidality if there are no suspicious or fearful symptoms and guilt. Engage in daily routine conversations with him and, if possible, stay in contact with one of his friends to gather information about any inappropriate behavior, if present.

Hope I have clarified your query.

Thank you.