Inflammation and treatment strategies for suicidal behavior.
Chittaranjan Behera, Srishti Gupta, Richard Shelton, Yogesh Dwivedi
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry June 1, 2026 Peer reviewed DOI: 10.1080/15622975.2026.2659772 via PubMed
Summary
Suicidal behavior is linked to inflammation, as individuals with such behavior have higher levels of pro-inflammatory cytokines and other markers. These inflammatory processes affect brain systems that regulate mood and behavior, potentially increasing impulsivity and suicidal thoughts. Various immunomodulatory treatments, like lithium and ketamine, may help reduce this inflammation and associated suicide risk. Tailoring treatment based on individual inflammatory profiles could enhance prevention strategies.
Study at a glance
| Design | narrative literature review |
|---|---|
| Population | individuals exhibiting suicidal behavior |
| Key finding | Immunomodulatory treatments, including lithium and ketamine, show promise in reducing inflammation linked to suicidal risk. |
Abstract
Suicide is a major global health problem. Growing evidence shows that immune dysregulation and inflammation contribute to suicidality. This review summarises inflammatory mechanisms associated with suicidal behaviour and evaluates emerging therapeutic strategies targeting these pathways. A narrative literature review was conducted using a combination of keywords, including suicide, therapy, pharmacotherapy, and inflammation, with Boolean operators across PubMed and Google Scholar, emphasising risk factors and interventions aimed at reducing inflammatory activity and consequent suicidal behaviour. Individuals with suicidal behaviour exhibit elevated pro-inflammatory cytokines (interleukin-6, interleukin-1β, tumour necrosis factor-α), C-reactive protein (CRP), and chemokines in blood, CSF, and brain tissue. These markers alter the hypothalamic-pituitary-adrenal (HPA) axis, monoamine systems, and glutamatergic signalling. Inflammatory activation of indoleamine 2,3-dioxygenase shifts tryptophan metabolism towards neurotoxic kynurenine metabolites, such as quinolinic acid, reducing serotonin and promoting NMDA-mediated excitotoxicity, potentially increasing impulsivity and acute suicidal ideation. Neuroinflammation also disrupts glutamate signalling through microglial/astrocytic dysfunction and altered Mammalian target of Rapamycin Complex 1 (mTORC1) pathways. Several immunomodulatory treatments - including lithium, ketamine/esketamine, cyclooxygenase-2 (COX-2) inhibitors, cytokine antagonists, and kynurenine-pathway modulators - show promise in reducing inflammation-linked to suicidal risk. Precision-based approaches integrating inflammatory biomarkers, genetics, and clinical profiles may help identify individuals most likely to benefit from immunomodulatory therapies, supporting more personalised, biologically informed suicide-prevention strategies.