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Existing and Novel Biological Therapeutics in Suicide Prevention

  • Joshua J. Griffiths
    Affiliations
    Department of Psychiatry, University of Colorado, Denver, Colorado
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  • Carlos A. Zarate Jr.
    Affiliations
    Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland
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  • J.J. Rasimas
    Correspondence
    Address correspondence to: Joseph J. Rasimas, MD, PhD, Psychiatry & Emergency Medicine, University of Minnesota & Penn State College of Medicine, Staff Psychiatrist & Medical Toxicologist, HealthPartners/Regions Hospital, 640 Jackson Street, Mailstop 12002A, Saint Paul MN 55101
    Affiliations
    Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland

    Departments of Psychiatry and Emergency Medicine, Penn State College of Medicine, Hershey, Pennsylvania
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      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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