Skip to main content Accessibility help

Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention?

  • Eimear Cleary (a1), Cecily C. Kelleher (a2), Abbie Lane (a3) and Kevin M. Malone (a3)



Restricting access to lethal means is an effective suicide prevention strategy. However, there is little discussion in the literature about the potential contribution of prescribing practices on discharge from inpatient psychiatric care (which has been established as a high-risk period for suicide) to suicide deaths by overdose of prescribed medication. This study aimed to assess the quantity, toxicity and potential lethality of psychotropic medication being prescribed on discharge from psychiatric care to those with and without indices of suicidality.


Patient demographic, clinical and prescription data were collected from 50 randomly selected charts following discharge from inpatient psychiatric care. Psychotropic medications (dose × duration) on discharge were converted to their equivalent doses of neuroleptics, antidepressants and anxiolytics to rate toxicity and potential lethality, using the Maudsley Prescribing Guidelines. Mood stabilizing medications were also documented.


39% of prescriptions analysed contained toxic and potentially fatal doses of either neuroleptic or antidepressant equivalent medication.


Patient discharge from inpatient psychiatric care presents a golden opportunity to moderate access to potentially fatal psychotropic medication. Iatrogenic provision of lethal means for suicide during a period of increased risk and in a group at increased suicide risk may impact suicide prevention efforts and requires further in-depth research. Current prescribing practices may be a missed opportunity to intervene in this regard.


Corresponding author

*Address for correspondence: K. M. Malone, Department of Psychiatry & Mental Health Research, UCD School of Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. (Email:


Hide All
Abou-Saleh, MT, Müller-Oerlinghausen, B, Coppen, AJ (2017). Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression. International Journal of Bipolar Disorders 5(1), 11.
Andreasen, NC, Pressler, M, Nopoulos, P, Miller, D, Ho, BC (2010). Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biological Psychiatry 67(3), 255262.
Appleby, L, Kapur, N, Shaw, J, Windfuhr, K, Hunt, IM, Flynn, S, Tham, SG (2016). The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report and 20 year review: England, Northern Ireland, Scotland and Wales. University of Manchester: Manchester.
Ashton, CH (2002). Benzodiazepines: How they Work and How to Withdraw. The Ashton Manual. Newcastle Upon Tyne. Newcastle University: England.
Buckley, NA, McManus, PR (2002). Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. British Medical Journal 325(7376), 13321333.
Capel, MM, Colbridge, MG, Henry, JA (2000). Overdose profiles of new antipsychotic agents. The International Journal of Neuropsychopharmacology 3(1), 5154.
Ernst, CL, Goldberg, JF (2004). Antisuicide properties of psychotropic drugs: a critical review. Harvard Review of Psychiatry 12(1), 1441.
Fernandes, V, Flak, E (2012). Safe and effective prescribing practices at the point of discharge from an inpatient psychiatry unit. Journal of Psychiatric Practice 18(1), 1219.
Hawton, K, Bergen, H, Simkin, S, Cooper, J, Waters, K, Gunnell, D, Kapur, N (2010). Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. The British Journal of Psychiatry 196(5), 354358.
Hayasaka, Y, Purgato, M, Magni, LR, Ogawa, Y, Takeshima, N, Cipriani, A, Furukawa, TA (2015). Dose equivalents of antidepressants: evidence-based recommendations from randomized controlled trials. Journal of Affective Disorders 180, 179184.
Lawrenson, RA, Tyrer, F, Newson, RB, Farmer, RDT (2000). The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. Journal of Affective Disorders 59(2), 149157.
Mental Health Commission (2009). Code of practice on admission, transfer and discharge to and from an approved centre ( Accessed 20 November 2016.
Minns, AB, Clark, RF (2012). Toxicology and overdose of atypical antipsychotics. Journal of Emergency Medicine 43(5), 906913.
Olfson, M, Marcus, SC, Bridge, JA (2014). Focusing suicide prevention on periods of high risk. Jama 311(11), 11071108.
Olfson, M, Wall, M, Wang, S, Crystal, S, Liu, SM, Gerhard, T, Blanco, C (2016). Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry 73(11), 11191126.
Procyshyn, RM, Bezchlibnyk-Butler, KZ, Jeffries, JJ (editors) (2017). Clinical Handbook of Psychotropic Drugs. Hogrefe Publishing: London.
Taylor, D, Paton, C, Kapur, S (2015). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons: London.
Thomsen, LA, Winterstein, AG, Sondergaard, B, Haugbolle, LS, Melander, A (2007). Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Annals of Pharmacotherapy 41(9), 14111426.
While, D, Bickley, H, Roscoe, A, Windfuhr, K, Rahman, S, Shaw, J, Kapur, N (2012). Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study. The Lancet 379(9820), 10051012.
Woods, SW (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. The Journal of Clinical Psychiatry 64(6), 663667.


Limiting psychotropic medication prescription on discharge from psychiatric inpatient care: a possible suicide intervention?

  • Eimear Cleary (a1), Cecily C. Kelleher (a2), Abbie Lane (a3) and Kevin M. Malone (a3)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.