Pharmacotherapy of suicidal ideation and behaviour

© 2000 John Wiley & Sons, Ltd. All rights reserved. Virtually all psychiatric disorders, but particularly recurrent mood disorders and schizophrenia, are associated with increased rates of suicide. The use of psychotropic drug treatment for the prevention of suicide is based on the principle that successful therapy of an underlying psychiatric disorder will decrease the risk of suicidal ideation and behaviour. While this has been difficult to establish from prospective trials, epidemiological studies suggest that rates of suicide are significantly lower in patients treated with antidepressants drugs and mood stabilizers. However, this effect could presumably be attributed to the fact that those who seek treatment are less likely to exhibit suicidal behaviour than those who do not. In addition, lower suicide rates of those in treatment may not be due to the specific effects of drug therapy. To some extent these caveats are offset by the fact that drug treatments appear to have differential effects on suicidal behaviour. For example, lithium may be more effective than carbamazepine in lowering suicide rates in patients with recurrent mood disorders. Similarly, the atypical antipsychotic drug, clozapine, is probably more effective than conventional antipsychotic agents in decreasing suicidal behaviour in patients with schizophrenia. While treatment with selective serotonin reuptake inhibitors may decrease impulsivity and suicide attempts in patients with personality disorders, benzodiazepines can produce the opposite effect. Whatever the precise mechanisms involved, current evidence suggests that the appropriate use of psychotropic medication in patients with recurrent or chronic psychiatric disorders can make a useful contribution to the reduction of suicide rates.