Sick of Feeling Sick: Management of Opioid Treatment-Induced Refractory Nausea Resulting in Suicidal Ideations With a Plan and Intent

TL;DR

A 60-year-old man with opioid dependence and mental health issues experienced severe nausea and suicidal thoughts, which were managed with a combination of medications.

Contribution

This case report presents a successful treatment strategy for opioid-induced refractory nausea leading to suicidal ideation.

Findings

A treatment plan using mirtazapine, scopolamine, and gabapentin effectively reduced nausea and anxiety.

The patient showed significant improvement in symptoms over nine days of inpatient care.

The case highlights the importance of tailored pharmacological interventions for complex psychiatric and medical conditions.

Abstract

In this case report, we present the case of a 60-year-old Caucasian male with a history of depression, anxiety, opioid dependence, and idiopathic polyneuropathy, admitted to an inpatient psychiatric unit for suicidal ideation. The patient's symptoms were characterized by months of intractable nausea, severe anxiety, suicidal ideation (SI), and significant unintentional weight loss in the context of methadone-assisted treatment. Over nine days in the hospital, a treatment strategy was developed and refined, which eventually achieved sustained relief from nausea and significant improvement in anxiety. The most effective pharmacological interventions included mirtazapine, scopolamine, and gabapentin.