Clinical consequences: excessive sedation, tolerance, risk of suicide

One of the important clinical consequences of the pharmacological management of severe depression, especially in refractory cases, is excessive sedation.

This adverse effect is frequently observed in treatments that include atypical antipsychotics such as olanzapine, quetiapine, or aripiprazole, commonly used as augmentation strategies.

Although these drugs have proven useful in cases of resistant depression, they can induce intense drowsiness that interferes with the patient's daily functioning.

This sedation not only impacts work and social performance but, as illustrated in the clinical cases presented, can hinder the recovery process by reducing the patient's ability to actively engage in complementary therapeutic activities such as psychotherapy or physical exercise.

Tolerance and treatment adjustments

Another relevant aspect is the development of tolerance to certain psychotropic drugs. This means that, over time, the same dose of the medication loses its effectiveness, requiring adjustments in dosage or additional combinations.

This situation is common in prolonged treatments, especially in chronic or resistant depression, and requires the clinician to monitor the patient carefully to avoid escalations that may increase side effects, such as weight gain, metabolic disturbances, or sexual dysfunction.

Tolerance can also lead to frustration for both the patient and the clinician, as it requires repeated rethinking of treatment regimens.

Suicide risk: critical alert

Perhaps the most critical consequence to consider is the risk of suicide. In the clinical presentation of severe depression, suicidal thoughts and hopelessness are frequently present. As detailed in the testimonials and clinical cases presented, some patients report persistent or recurrent suicidal ideation, even in the presence of multiple treatments.

This underscores the need for rigorous and constant assessment of suicide risk at each consultation, especially in patients with a history of refractoriness. In addition, in the first days of treatment with antidepressants, a clinical paradox may occur: initial improvement in psychomotor act