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Clinical Crossroads Update
April 4, 2001

A 52-Year-Old Suicidal Man, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2001;285(13):1757. doi:10.1001/jama.285.13.1757

At Psychiatry Grand Rounds in February 2000, Douglas G. Jacobs, MD, discussed a suicidal 52-year-old man.1 The patient, Mr D, almost jumped in front of a train after piling up gambling debts and losing his family's support. During a psychiatric hospitalization, Mr D related his history of compulsive gambling. He described his mood as "hopeless" with feelings of shame and guilt about his life failures. He received fluoxetine hydrochloride, 40 mg/d, and trazodone, 50 mg at bedtime. Due to refractory depression, he received a course of electroconvulsive therapy that continued after his discharge from the hospital.

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