Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-02T13:21:41.128Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of psychopharmacology in suicide prevention

Published online by Cambridge University Press:  11 April 2011

Kate E. A. Saunders  and
Keith Hawton
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The potential role of psychopharmacology in suicide prevention is often minimised. This may to some extent reflect that few medication trials have specifically focussed on prevention of suicidal behaviour – indeed this outcome is often not reported in trials. However, there is reasonably strong evidence that lithium may reduce risk of suicide, the postulated mechanism being a specific effect on aggression. Evidence is lacking with regard to any protective effect of other mood stabilizers. Clozapine may reduce suicidal behaviour in patients with schizophrenia, with reduction of affective symptoms being a possible explanation. The role of antidepressants in relation to suicide risk is highly controversial, especially in children and adolescents. It is unclear whether minor tranquillizers or hypnotics can assist in suicide prevention, although they can reduce the anxiety symptoms that may occur during initial treatment with SSRI antidepressants. Itis also uncertain whether psychopharmacology has a role in preventing suicidal behaviour in people with personality disorders. Despite the limitations of the evidence we contend that suicide risk should be an important factor in deciding when and what to prescribe.

Declaration of Interest: We have no interests to declare.

Type
Editorials
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 3 , September 2009 , pp. 172 - 178
Copyright
Copyright © Cambridge University Press 2009

References

REFERENCES

Angst, J. & Clayton, P. (1986). Premorbid personality of depressive, bipolar, and schizophrenic patients with special reference to suicidal issues. Comprehensive Psychiatry 27, 511–532.CrossRefGoogle ScholarPubMed
Avery, D. & Winokur, G. (1978). Suicide, attempted suicide, and relapse rates in depression. Archives of General Psychiatry 35, 749–753.CrossRefGoogle ScholarPubMed
Baldessarini, R.J., Tondo, L. & Hennen, J. (2003).Lithium treatment and suicide risk in major affective disorders: update and new findings. Journal of Clinical Psychiatry 64, Suppl. 5, 44–52.Google ScholarPubMed
Baldessarini, R.J., Pompili, M. & Tondo, L. (2006). Suicidal risk in antidepressant drug trials. Archives of General Psychiatry 63, 246–248.CrossRefGoogle ScholarPubMed
Bauer, M.S., Wisniewski, S.R., Kogan, J.N., Marangell, L.B., Thase, M.E. & Sachs, G. (2006). Brief report: paroxetine in younger and adult individuals at high risk for suicide. Psychopharmacology Bulletin 39, 31–37.Google ScholarPubMed
Bourgon, L.N. & Kellner, C.H. (2000). Relapse of depression after ECT: a review. Journal of ECT 16, 19–31.CrossRefGoogle ScholarPubMed
Bradvik, L. & Berglund, M. (2005). Suicide in severe depression related to treatment: depressive characteristics and rate of antidepres-sant overdose. European Archives of Psychiatry and Clinical Neuroscience 255, 245–250.CrossRefGoogle ScholarPubMed
Bradvik, L. & Berglund, M. (2006). Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharma-cotherapy may have different effects on the occurrence and seriousness of suicide attempts. Depression and Anxiety 23, 34–41.CrossRefGoogle Scholar
Bridge, J.A., Iyengar, S., Salary, C.B., Barbe, R.P., Birmaher, B., Pincus, H.A., Ren, L. & Brent, D.A. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepres-sant treatment: a meta-analysis of randomized controlled trials. Journal of American Medical Association 297, 1683–1696.CrossRefGoogle ScholarPubMed
Cavanagh, J.T., Carson, A.J., Sharpe, M. & Lawrie, S.M. (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.CrossRefGoogle ScholarPubMed
Cipriani, A., Pretty, H., Hawton, K. & Geddes, J.R. (2005). Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. American Journal of Psychiatry 162, 1805–1819.CrossRefGoogle ScholarPubMed
Coccaro, E.F. & Kavoussi, R.J. (1997). Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Archives of General Psychiatry 54, 1081–1088.CrossRefGoogle ScholarPubMed
Fawcett, J., Scheftner, W.A., Fogg, L., Clark, D.C., Young, M.A., Hedeker, D. & Gibbons, R. (1990). Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry 147, 1189–1194.Google ScholarPubMed
Fenton, W.S., McGlashan, T.H., Victor, B.J. & Blyler, C.R. (1997). Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry 154, 199–204.Google ScholarPubMed
Fergusson, D., Doucette, S., Glass, K.C., Shapiro, S., Healy, D., Hebert, P. & Hutton, B. (2005). Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. British Medical Journal 330, 396.CrossRefGoogle ScholarPubMed
Flood, R.A. & Seager, C.P. (1968). A retrospective examination of psychiatric case records of patients who subsequently committed suicide. British Journal of Psychiatry 114, 443–450.CrossRefGoogle ScholarPubMed
Geddes, J., Burgess, S., Hawton, K., Jamison, K. & Goodwin, G.M. (2004). Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. American Journal of Psychiatry 161, 217–222.CrossRefGoogle ScholarPubMed
Gibbons, R.D., Brown, C.H., Hur, K., Marcus, S.M., Bhaumik, D.K., Erkens, J.A., Herings, R.M. & Mann, J.J. (2007). Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. American Journal of Psychiatry 164, 1356–1363.CrossRefGoogle ScholarPubMed
Goldberg, J.F., Allen, M.H., Miklowitz, D.A., Bowden, C.L., Endick, C.J., Chessick, C.A., Wisniewski, S.R., Miyahara, S., Sagduyu, K., Thase, M.E., Calabrese, J.R. & Sachs, G.S. (2005). Suicidal ideation and phar-macotherapy among STEP-BD patients. Psychiatric Services 56, 1534–1540.CrossRefGoogle Scholar
Goodwin, F.K., Fireman, B., Simon, G.E., Hunkeler, E.M., Lee, J. & Revicki, D. (2003). Suicide risk in bipolar disorder during treatment with lithium and divalproex. Journal of the American Medical Association 290, 1467–1473.CrossRefGoogle ScholarPubMed
Hall, R.C. & Joffe, J.R. (1972). Aberrant response to diazepam: a new syndrome. American Journal of Psychiatry 129, 738–742.CrossRefGoogle ScholarPubMed
Haw, C., Hawton, K., Houston, K. & Townsend, E. (2001). Psychiatric and personality disorders in deliberate self-harm patients. British Journal of Psychiatry 178, 48–54.CrossRefGoogle ScholarPubMed
Hawton, K., Sutton, L., Haw, C., Sinclair, J. & Deeks, J.J. (2005a). Schizophrenia and suicide: systematic review of risk factors. British Journal of Psychiary 187, 9–20.CrossRefGoogle ScholarPubMed
Hawton, K., Sutton, L., Haw, C., Sinclair, J. & Harriss, L. (2005b). Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. Journal of Clinical Psychiatry 66, 693–704.CrossRefGoogle ScholarPubMed
Jonas, J.M. & Hearron, A.E. Jr, (1996). Alprazolam and suicidal ideation: a meta-analysis of controlled trials in the treatment of depression. Journal of Clinical Psychopharmacology 16, 208–211.CrossRefGoogle ScholarPubMed
Khan, A., Khan, S.R., Leventhal, R.M. & Brown, W.A. (2001). Symptom reduction and suicide risk among patients treated with placebo in antipsychotic clinical trials: an analysis of the food and drug administration database. American Journal of Psychiatry 158, 1449–1454.CrossRefGoogle ScholarPubMed
Khan, A., Khan, S., Kolts, R. & Brown, W.A., 2003. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. American Journal of Psychiatry 160, 790–792.CrossRefGoogle ScholarPubMed
Lauterbach, E., Felber, W., Muller-Oerlinghausen, B., Ahrens, B., Bronisch, T., Meyer, T., Kilb, B., Lewitzka, U., Hawellek, B., Quante, A., Richter, K., Broocks, A. & Hohagen, F. (2008). Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial. Acta Psychiatrica Scandinavica 118, 469–479.CrossRefGoogle ScholarPubMed
Leon, A.C., Marzuk, P.M., Tardiff, K. & Teres, J.J. (2004). Paroxetine, other antidepressants, and youth suicide in New York City: 1993 through 1998. Journal of Clinical Psychiatry 65, 915–918.CrossRefGoogle ScholarPubMed
Lindenmayer, J.P., Czobor, P., Alphs, L., Nathan, A.M., Anand, R., Islam, Z. & Chou, J.C. (2003). The InterSePT scale for suicidal thinking reliability and validity. Schizophrenia Research 63, 161–170.CrossRefGoogle ScholarPubMed
Mann, J.J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., Varnik, A., Wasserman, D., Yip, P. & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294, 2064–2074.CrossRefGoogle ScholarPubMed
Meltzer, H.Y. & Okayli, G. (1995). Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. American Journal of Psychiatry 152, 183–190.Google ScholarPubMed
Meltzer, H.Y., Alphs, L., Green, A.I., Altamura, A.C., Anand, R., Bertoldi, A., Bourgeois, M., Chouinard, G., Islam, M.Z., Kane, J., Krishnan, R., Lindenmayer, J.P. & Potkin, S. (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Archives of General Psychiatry 60, 82–91.CrossRefGoogle ScholarPubMed
Moller, H.J. (2006). Evidence for beneficial effects of antidepressants on suicidality in depressive patients: a systematic review. European Archives of Psychiatry and Clinical Neuroscience 256, 329–343.CrossRefGoogle ScholarPubMed
Montgomery, S.A. & Montgomery, D. (1982). Pharmacological prevention of suicidal behaviour. Journal of Affective Disorders 4, 291–298.CrossRefGoogle ScholarPubMed
Montgomery, S.A., Montgomery, D.B., Rani, S.J., Roy, P.H., Shaw, P.J. & McAuley, R. (1979). Maintenance therapy in repeat suicide behaviour – A Placebo controlled trial. In Proceedings of the 10th International Congress of Suicide Prevention and Crisis Intervention, pp. 227–229.Google Scholar
Muller-Oerlinghausen, B., Muser-Causemann, B. & Volk, J. (1992). Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective Disorders 25, 261–269.CrossRefGoogle Scholar
Neutel, C.I. & Patten, S.B. (1997). Risk of suicide attempts after ben-zodiazepine and/or antidepressant use. Annals of Epidemiology 7, 568–574.CrossRefGoogle ScholarPubMed
Palmer, B.A., Pankratz, V.S. & Bostwick, J.M. (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry 62, 247–253.CrossRefGoogle ScholarPubMed
Rihmer, Z. & Akiskal, H. (2006). Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antide-pressant-suicidality FDA advisory in light of declining national suicide statistics from many countries. Journal of Affective Disorders 94, 3–13.CrossRefGoogle Scholar
Roy, A. (1982). Suicide in chronic schizophrenia. British Journal of Psychiatry 141, 171–177.CrossRefGoogle ScholarPubMed
Ryan, H.F., Merrill, F.B., Scott, G.E., Krebs, R. & Thompson, B.L. (1968). Increase in suicidal thoughts and tendencies. Association with diazepam therapy. Journal of the American Medical Association 203, 1137–1139.CrossRefGoogle ScholarPubMed
Sernyak, M.J., Desai, R., Stolar, M. & Rosenheck, R. (2001). Impact of clozapine on completed suicide. American Journal of Psychiatry 158, 931–937.CrossRefGoogle ScholarPubMed
Sharma, V. (1999). Retrospective controlled study of inpatient ECT: does it prevent suicide? Journal of Affective Disorders 56, 183–187.Google Scholar
Shi, L., Thiebaud, P. & McCombs, J.S. (2004). The impact of unrecognized bipolar disorders for patients treated for depression with anti-depressants in the fee-for-services California Medicaid (Medi-Cal) program. Journal of Affective Disorders 82, 373–383.Google Scholar
Simon, G.E., Savarino, J., Operskalski, B. & Wang, P.S. (2006). Suicide risk during antidepressant treatment. American Journal of Psychiatry 163, 41–47.CrossRefGoogle ScholarPubMed
Smith, E.G., Sondergard, L., Lopez, A.G., Andersen, P.K. & Kessing, L.V. (2009). Association between consistent purchase of anticonvul-sants or lithium and suicide risk: A longitudinal cohort study from Denmark, 1995–2001. Journal of Affective Disorders Feb 23 [Epub ahead of print].CrossRefGoogle Scholar
Sondergard, L., Lopez, A.G., Andersen, P.K. & Kessing, L.V. (2008). Mood-stabilizing pharmacological treatment in bipolar disorders and risk of suicide. Bipolar Disorders 10, 87–94.CrossRefGoogle ScholarPubMed
Tondo, L. & Baldessarini, R.J. (2000). Reduced suicide risk during lithium maintenance treatment. Journal of Clinical Psychiatry 61, Suppl. 9, 97–104.Google ScholarPubMed
Tran, P.V., Hamilton, S.H., Kuntz, A.J., Potvin, J.H., Andersen, S.W., Beasley, C. Jr, & Tollefson, G.D. (1997). Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders. Journal of Clinical Psychopharmacology 17, 407–418.CrossRefGoogle ScholarPubMed
Valuck, R.J., Libby, A.M., Sills, M.R., Giese, A.A. & Allen, R.R. (2004). Antidepressant treatment and risk of suicide attempt by adolescents with major depressive disorder: a propensity-adjusted retrospective cohort study. CNS Drugs 18, 1119–1132.CrossRefGoogle ScholarPubMed
Verkes, R.J., Van der Mast, R.C., Hengeveld, M.W., Tuyl, J.P., Zwinderman, A.H. & Van Kempen, G.M. (1998). Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression. American Journal of Psychiatry 155, 543–547.CrossRefGoogle Scholar
Walker, A.M., Lanza, L.L., Arellano, F. & Rothman, K.J. (1997). Mortality in current and former users of clozapine. Epidemiology 8, 671–677.CrossRefGoogle ScholarPubMed
Ward, A., Ishak, K., Proskorovsky, I. & Caro, J. (2006). 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. Clinical Therapy 28, 1912–1921.CrossRefGoogle ScholarPubMed
Wheeler, B.W., Gunnell, D., Metcalfe, C., Stephens, P. & Martin, R.M. (2008). The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study. British Medical Journal 336, 542–545.CrossRefGoogle ScholarPubMed
Wickham, E.A. & Reed, J.V. (1987). Lithium for the control of aggressive and self-mutilating behaviour. International Clinical Psychopharmacology 2, 181–190.CrossRefGoogle ScholarPubMed
Winokur, G. & Tsuang, M. (1975). The Iowa 500: suicide in mania, depression, and schizophrenia. American Journal of Psychiatry 132, 650–651.Google ScholarPubMed
Yerevanian, B.I., Koek, R.J. & Mintz, J. (2003). Lithium, anticonvul-sants and suicidal behavior in bipolar disorder. Journal of Affective Disorders 73, 223–228.CrossRefGoogle ScholarPubMed
Yerevanian, B.I., Koek, R.J. & Mintz, J. (2007a). Bipolar pharma-cotherapy and suicidal behavior: Part 3: Impact of antipsychotics. Journal of Affective Disorders 103, 23–28.CrossRefGoogle Scholar
Yerevanian, B.I., Koek, R.J., Mintz, J. & Akiskal, H.S. (2007b). Bipolar pharmacotherapy and suicidal behavior: Part 2. The impact of antidepressants. Journal of Affective Disorders 103, 13–21.CrossRefGoogle ScholarPubMed
Youssef, N.A. & Rich, C.L. (2008). Does acute treatment with sedatives/hypnotics for anxiety in depressed patients affect suicide risk? A literature review. Annals of Clinical Psychiatry 20, 157–169.CrossRefGoogle ScholarPubMed