Valid suicide threat, or gesture?

August 9, 2006 10:27 AM

I have a friend who is stockpiling Klonopin for his next suicide overdose/gesture. He currently has 180 2mg tablets of Klonopin. Is that enough to kill a 350 lb man?

Last year he took 200 100mg tablets of Seroquel and went into a week-long coma. He woke up in the psych ward. I don't want to encourage his dramatic behavior if the Klonopin isn't really lethal, but if it is dangerous, I will tell his spouse and therapist.

posted by RussHy to Health & Fitness (30 answers total)

Any suicide gesture is serious and valid, whether or not it accompanies drama. Please assist your friend in getting help.
posted by moira at 10:31 AM on August 9, 2006

Best answer: the ld 50 of klonopin is over 4000mg/kg but i don't think this question will last long
posted by killyb at 10:32 AM on August 9, 2006

Is that enough to kill a 350 lb man?

Who cares? Fifty tabs of Tylenol will kill you. Get him help. Soon.
posted by frogan at 10:34 AM on August 9, 2006

if it is dangerous, I will tell his spouse and therapist.

This is something they should know even if it weren't dangerous. Which it is. Tell them immediately.
posted by orange swan at 10:36 AM on August 9, 2006

If he told you this, then he is indirectly asking you for help. You need to do something.
posted by divka at 10:36 AM on August 9, 2006

For fuck's sake, you have to be told to tell them? Get off the computer and find a phone, now.
posted by Zozo at 10:39 AM on August 9, 2006 [1 favorite]

Not nearly enough. Klonopin is not terribly toxic. This is a cry for help.
posted by geoff. at 10:41 AM on August 9, 2006

Best answer: My guess is that this is a gesture in the broadest sense of the word. I say this because he's already tried to overdose on his meds and it didn't work; in fact, it did exactly the opposite and got him admitted to a place where everyone there was committed to saving his life. It's possible that he wants to be admitted again, and this may be the only way he can think to do it.

But it may not be simply a gesture in the sense that he may very well intend to take all those pills all at the same time; he just may not intend that this action will end his life.

Telling his therapist is crucial. If your friend really wants to die, he'll find a way to end his own life. If he never gets to that point, he needs the help that's available to him now.

Make the phone calls now.
posted by jesourie at 10:41 AM on August 9, 2006

Best answer: The internets label the LD50 for this drug at 4000 mg/Kg, or a dose of 632,000 mg for a 350 lb man.

That's just the technical side of things, and the internets are often very wrong. Get him help anyways.
posted by shepd at 10:42 AM on August 9, 2006

"If he told you this, then he is indirectly asking you for help. You need to do something."

But what if Russ can't afford to buy him more Klonopin?

Tell your friend that you're sick of his drama, but that suicide isn't the answer. I do wonder, though, what Klonopin is being prescribed to him for. My ma got it for migranes (and it's generally, as far as I understand, for epileptics). You might want to point out that his behavior is, like, really unhealthy and that he should pursue medical advice for his depression instead of trying to make some sort of gesture for attention.
posted by klangklangston at 10:42 AM on August 9, 2006

Best answer: Man, pardon my French up there, but regardless of whether or not he'll be successful in it, he's planning another suicide attempt. What if he does the research himself and finds out it'd take two pounds of Klonopin to kill him, so he goes for those fifty tabs of Tylenol instead?

I honestly can't believe you're asking us this. You say you're this guy's friend? Then be a friend to him.
posted by Zozo at 10:43 AM on August 9, 2006

No, it's almost totally impossible if the LD50 (dose at which 50% die) numbers I googled for are anywhere near accurate.

Totally beside the point though. TELL SOMEONE NOW. You're fine with him being miserable, as long as he doesn't die?! Have some humanity.
posted by phrontist at 10:44 AM on August 9, 2006

I do wonder, though, what Klonopin is being prescribed to him for.

Probably anxiety. It's both an anticonvulsant and an anxiolytic.
posted by jesourie at 10:45 AM on August 9, 2006

If someone wants to kill themselves, they will. I am by no means a psychiatrist (and on most days I don't have enough energy to care about other people's drama), but if your friend is going to such long-term efforts to kill themselves, it sounds like a desperate cry for attention more than anything. If he really wanted to be dead, he'd be in the ground. I know it's cliched, but death is easy, living is what takes effort.

If nothing else, get him some help. Even if the pill cocktail doesn't kill him, the side-effects of massive doses of medication are pretty brutal. Someone mentioned downing a bottle of Tylenol ... Brutal way to go, as you usually survive for a while with acid for blood, dying days / weeks later from massive pain and organ failure.

Get him some help. He sounds like a drama queen, not seriously suicidal. Just my cold-hearted 2¢.
posted by Dark Messiah at 10:45 AM on August 9, 2006

You also might want to show him this page, although that's probably a judgement call...
posted by Dark Messiah at 10:48 AM on August 9, 2006

It's extremely difficult to kill yourself with Klonopin. Most men, if they really want to die, will shoot themselves in the head. Or jump off a tall building. Or hang themselves. You get the idea.

Pills are not a method used in an actual attempt to cause your own death, they are a plea for either help or attention, depending on the person. If you are actually asking this question for yourself using the subtle friend ruse, I urge you to seek counseling. If you really are asking for a friend, you should tell your friend's spouse.

But also refuse to get dragged into the repetitive "I'm going to kill myself!" drama. People intent to die just do it. People who constantly tell other people they're going to kill themselves are looking to be told what a swell person they are.
posted by Justinian at 10:53 AM on August 9, 2006

Response by poster: Zozo, et al. Thanks for the kick in the butt.

I made the calls. He needs help which I can't give. I feel manipulated, again, bacause HE should take resposibility for his problems, instead of manipulating his friends and family into doing what needs to be done. It just gets old. I feel burned out from all the drama over the years. He's bipolar and borderline. He's a good friend, mostly, except for the constant recurring depressions that I can't fix. When he's manic he's great fun and brilliant. What a mess.

It occurs to me that this post is actually the kind of thing that he would do. Shit! Borderline personality disorder seems contagious.
posted by RussHy at 10:57 AM on August 9, 2006

Oh, for reference. If you kept taking 2 mg "bars" of klonopin (the big ones) until they killed you, you would die from your stomach rupturing long before the dosage was high enough to cause death. Fun.

(Ok, you'd actually probably pass out first, but theoretically.)
posted by Justinian at 11:00 AM on August 9, 2006

as a side point taking pills to off yourself is stupid. If you don't do it right you wind up in a nursing home drooling on yourself.

Anytime a bipolar acts suicidal one needs to see it as a medical emergency. The borderline diagnose makes it tricksy as generally they like to generate drama but bottom line it is an illness and no matter what the root cause of the attempt it needs to be dealt with. These people are in a lot of pain and this is how it comes out.
posted by konolia at 11:04 AM on August 9, 2006

RussHy, good for you. That's an astute reading of the situation. And apologies again for coming across so harshly.
posted by Zozo at 11:04 AM on August 9, 2006

I've had two friends commit suicide after a history of threats. I can't say that I feel too badly about not playing along with their drama -- clearly, they didn't care all that much about their families or about me and their other friends.

Were it me, I would not have made the calls; I'd have washed my hands of the guy, and let him make dramatic overtures to others.
posted by solid-one-love at 11:05 AM on August 9, 2006

As for your friend taking responsibility for his problems ... you're right and you're wrong. He should take responsibility to get healthy, but when he is really sick, super-depressed, freaked out, a cry for help and/or attention may be the best he can do.

You're a good friend, both for caring enough to look after his well-being and for making a call I'm sure he would have dreaded making himself. But if it becomes too much for you to handle, you should take care of yourself and back away for awhile. Although you should make sure he has a support network of doctors before you leave him hanging.

And people who commit suicide aren't necessarily people who don't care about others. Sometimes it's just the opposite, and sometimes it gets to a point where it's about what a person can bear in his or her mind. When the demons get too evil, everything else goes out the window.
posted by brina at 11:27 AM on August 9, 2006

It's never one person's responsibility to look after and be responsible for another's melodramtic suicide gestures. It gets old, and you (and everyone else in such a situation) are well within your rights to walk the hell away. Life's too short to be beholden to these sorts of people.
posted by xmutex at 11:46 AM on August 9, 2006

Bit of a derail. You might mention to him the effect his suicide would have on those who care about him. I've seen two extended families fall completely apart after a loved one off'd themselves. I really don't think they'd have done it if they fully considered the people they were leaving behind.
posted by Carbolic at 12:09 PM on August 9, 2006

The LD50 rates do not take into account Klonopin's interaction with alcohol, which is a frequent "chaser" in suicide attempts. This is all beside the point, as you have an ethical duty to rat him out to his spouse and doctor ASAP.
posted by Saucy Intruder at 12:11 PM on August 9, 2006

A few things:

Pass off the problem. Don't attend to the threat. If he has that much Clonazepam, he doesn't have it legally. A call to the police with exact information about the location of the stockpile, without your direct involvement, will compel the police to do a "hold and treat" with an evaluation for at least 24 hours. If he is really serious or attention seeking, he will tell the cops that he is suicidal which will require a "hold and treat." At the very least, someone will alert the doctor and/or the DEA to find out who Dr. Feelgood is.

Make sure to be clear to him that you disengaged when you found out. Let him know to contact you when he is healthy again, and that keeping you in the loop is abusive of your friendship and relationship. Talk to him when he is not being dramatic as you would any good friend, and thank him for being a good friend and respecting you when he isn't being such a prick. You might not use that particular language!

Also, if he truly OD'd on the anti-psychotic, he probably has organ damage. The more the renal system and/or liver gets trashed by these idiotic dramas, the less his body can take of the latter attempts So the LD50 could be much lower for a guy with trashed kidneys, liver, etc.

Lastly: benzodiazepines like Ativan and Klonopin have some really severe side effects that exacerbate depression. Sometimes psychotically. You have to really poke around to find those data, and these data aren't like the data on SSRIs -- they are less confounded. A close look will find the red flags, but few prescribers know this. The guy shouldn't be on benzos if he is battling depression.

Good luck. Light fuse and get away.
posted by mezzanayne at 12:11 PM on August 9, 2006

Best answer: I am a bit stunned by a few of the glib responses. For heavens sake--the man is bipolar, weighs 350 lbs, has a history of a serious suicide attempt, etc. One can be helpful and intervene without assuming responsibility. None of us know for sure whether this is or is not manipulation or the extent of his depression or fear of a deep depression. I do not find it at all unusual for a person with bipolar illness to stockpile drugs as a safety valve against the fear of a depression that might be so severe that suicide is seen as realsitic relief. ALso, I am not sure how one of you came to the conclusion that he could not possibly have that many drugs legally--of course he could. Simple stockpiling on refillable or even non refillable presecriptions. He could simply lie to his physician and say they are quite helpful. I don't believe misleading your physician or not taking a prescription is illegal. A drug bust is not a reasonable way to secure a 24 hour hold for evaluation. Klonopin is usually not indicated in depression but many forms of depression (if not most) are accompanied by anxiety which is an approriate use of Klonopin (although 2 mg is a high dose for psychiatric illnesses). On the other hand he weighs 350 lbs. Thanks for being a friend and follow your heart and values and not some of our advice.
posted by rmhsinc at 5:01 PM on August 9, 2006 [3 favorites]

Doctors can write prescriptions for a three month supply of maintenance meds through some health insurance prescription-by-mail benefits. This helps keep costs down. If your friend is getting prescriptions for that three month supplies, maybe he shouldn't be.

btw, some anticonvulsants have off-label use as mood stabilizers. explore crazymeds, though the entry on klonopin is pretty scant compared to the rest of the site.
posted by bleary at 7:32 PM on August 9, 2006

So is he bipolar or borderline, or both? They are not the same thing.

Mezzanayne, you'd be surprised how easy it is to legally have that much Klonopin. If I'd been getting refills all the time I was on it and not taking it all along, I'd have tons of it.
posted by IndigoRain at 7:49 PM on August 9, 2006

Best answer: A borderline sufferer does not enjoy creating drama. They are in intense emotional pain and are thrashing around trying to relieve that pain using the only methods they know how to use. Asking for help *is* taking responsibility for the situation because they don't know what else they can do. If you're drowning and don't know how to swim, then it's not abdicating responsbility to ask someone to throw you a lifering.
posted by talitha_kumi at 2:46 AM on August 10, 2006