We summarize outcomes for several pharmacologic and neurostimulatory approaches that
have been considered potential treatments to reduce suicide risk, namely, by reducing
suicide deaths, attempts, and ideation in various clinical populations. Available
treatments include clozapine, lithium, antidepressants, antipsychotics, electroconvulsive
therapy, and transcranial magnetic stimulation. The novel repurposing of ketamine
as a potential suicide risk–mitigating agent in the acute setting is also discussed.
Research pathways to better understand and treat suicidal ideation and behavior from
a neurobiological perspective are proposed in light of this foundation of information
and the limitations and challenges inherent in suicide research. Such pathways include
trials of fast-acting medications, registry approaches to identify appropriate patients
for trials, identification of biomarkers, neuropsychological vulnerabilities, and
endophenotypes through the study of known suicide risk–mitigating agents in hope of
determining mechanisms of pathophysiology and the action of protective biological
interventions.
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References
- SUPRE information leaflet.WHO, Geneva2002
- Leading causes of unintentional and intentional injury mortality: U.S., 2000–2009.Am J Public Health. 2012; 102: e84-e92
- Trends in suicide rates among persons ages 10 years and older, by sex, U.S., 1991–2009.CDC, Atlanta GA2014
- Psychological autopsy studies of suicide: a systematic review.Psychol Med. 2003; 33: 395-405
- Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries.Int J Soc Psychiatry. 2013; 59: 545-554
- Toward a clinical model of suicidal behavior in psychiatric patients.Am J Psychiatry. 1999; 156: 181-189
- Suicide prevention interventions and referral/follow-up services: a systematic review.Department of Veterans Affairs, Health Services Research and Development Service, Washington DC2012 (VA-ESP Project #05-225. www.hsrd.research.va.gov/publications/esp/suicide-interventions.pdf)
O’Connor E, Gaynes B, Burda BU, et al. Screening for suicide risk in primary care: a systematic evidence review for the U.S. Preventive Services Task Force. ncbi.nlm.nih.gov/books/NBK137737/.
NICE. Self-harm: the NICE guideline on longer-term management. nccmh.org.uk/guidelines_selfharm_ltm.html.
- Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice?.Am J Psychiatry. 2002; 159: 469-473
- Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data.Lancet. 2004; 363: 1341-1345
- Diagnostic and statistical manual of mental disorders.5th ed. APA, Washington DC2013
- Best practice elements of multilevel suicide prevention strategies.Crisis. 2011; 32: 319-333
- Psychiatrists’ attitude towards and knowledge of clozapine treatment.J Psychopharmacol. 2010; 24: 965-971
Pharmacy Times. Top 200 drugs of 2011. Plainsboro NJ: Pharmacy Times, 2012. www.pharmacytimes.com/_media/_pdf/Top_200_Drugs_2011_Total_Rx.pdf.
- Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).Arch Gen Psychiatry. 2003; 60: 82-91
- Reducing suicide risk in schizophrenia: focus on the role of clozapine.CNS Drugs. 2000; 14: 355-365
- Clozapine markedly elevates pregnenolone in rat hippocampus, cerebral cortex, and serum: candidate mechanism for superior efficacy?.Pharmacol Biochem Behav. 2006; 84: 598-608
- Intracellular modulation of NMDA receptor function by antipsychotic drugs.J Neurosci. 2000; 20: 4011-4020
- Effects of chronic clozapine administration on markers of arachidonic acid cascade and synaptic integrity in rat brain.Psychopharmacology. 2012; 222: 663-674
- Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy.J Affect Disord. 2009; 117: S26-S43
- Pilot randomized clinical trial of an SSRI vs bupropion: effects on suicidal behavior, ideation, and mood in major depression.Neuropsychopharmacology. 2012; 37: 697-706
- Treatment of suicide attempters with bipolar disorder: a randomized clinical trial comparing lithium and valproate in the prevention of suicidal behavior.Am J Psychiatry. 2011; 168: 1050-1056
- Differential pattern of response in mood symptoms and suicide risk measures in severely ill depressed patients assigned to citalopram with placebo or citalopram combined with lithium: role of lithium levels.J Psychiatr Res. 2011; 45: 1489-1496
- Treatment emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial.Depress Anxiety. 2011; 28: 303-309
- Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial.Acta Psychiatr Scand. 2008; 118: 469-479
- Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: a randomized, double-blind, placebo-controlled pilot study.J Clin Psychiatry. 2008; 69: 1228
- Suicide prevention by lithium SUPLI—challenges of a multi-center prospective study.Arch Suicide Res. 2005; 9: 27-34
- Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression.Am J Psychiatry. 1998; 155: 543-547
- Neurobiological aspects of suicide and suicide attempts in bipolar disorder.Transl Neurosci. 2013; (In press)
- Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials.Am J Psychiatry. 2005; 162: 1805-1819
- Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis.BMJ. 2013; 346: f3646
- Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review.Bipolar Disorders. 2006; 8: 625-639
- The suicide-preventive and mortality reducing effect of lithium.Lithium in neuropsychiatry: the comprehensive guide. Informa Healthcare, Oxfordshire2006
- Lithium treatment reduces suicide risk in recurrent major depressive disorder.J Clin Psychiatry. 2007; 68: 380-383
- Arguments for the specificity of the antisuicidal effect of lithium.Eur Arch Psychiatry Clin Neurosci. 2001; 251: S1172-S1175
- Decrease in suicide among the individuals treated with antidepressants: a controlled study of antidepressants in suicide, Sweden 1995–2005.Acta Psychiatrica Scandinavica. 2009; 120: 37-44
- Epidemiological data suggest antidepressants reduce suicide risk among depressives.J Affect Disorders. 1996; 41: 1-8
- Analysis of suicidality in pooled data from 2 double-blind, placebo-controlled aripiprazole adjunctive therapy trials in major depressive disorder.J Clin Psychiatry. 2011; 72: 548-555
- Compliance with refilling prescriptions for atypical antipsychotic agents and its association with the risks for hospitalization, suicide, and death in patients with schizophrenia in Quebec and Saskatchewan: a retrospective database study.Clin Ther. 2006; 28: 1912-1921
- The role of psychopharmacology in suicide prevention.Epidemiol Psychiatr Soc. 2009; 18: 172-178
- Bipolar pharmacotherapy and suicidal behavior: part 3: impact of antipsychotics.J Affect Disorders. 2007; 103: 23-28
- Transcranial direct current stimulation in severe, drug-resistant major depression.J Affect Disord. 2009; 118: 215-219
- A randomized trial of an N-methyl-d-aspartate antagonist in treatment-resistant major depression.Arch Gen Psychiatry. 2006; 63: 856-864
- Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial.Biol Psychiatry. 2012; 71: 939-946
- Antidepressant effects of ketamine in depressed patients.Biol Psychiatry. 2000; 47: 351-354
- Synaptic mechanisms underlying rapid antidepressant action of ketamine..Am J Psychiatry. 2012; 169: 1150-1156
- GLYX-13, a NMDA receptor glycine-site functional partial agonist, induces antidepressant-like effects without ketamine-like side effects.Neuropsychopharmacology. 2013; 38: 729-742
- A randomized trial of a low-trapping nonselective N-methyl-d-aspartate channel blocker in major depression.Biol Psychiatry. 2012; S0006-3223: 941-949
- Rapid resolution of suicidal ideation after a single infusion of an N-methyl-d-aspartate antagonist in patients with treatment-resistant major depressive disorder.J Clin Psychiatry. 2010; 71: 1605-1611
- Connecting inflammation with glutamate agonism in suicidality.Neuropsychopharmacology. 2013; 38: 743-752
- A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department.Int J Neuropsychopharmacol. 2011; 14: 1127-1131
- Standardization, integration, and sharing-leveraging research investments.Biol Psychiatry. 2011; 70: 5-6
- A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders.Psychol Med. 2013; 44: 1663-1673
- Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication.Mol Psychiatr. 2009; 15: 868-876
- 5-HIAA, cortisol and DHEAS levels in suicide attempters.Eur Neuropsychopharmacol. 2013; 23: 1280-1287
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