Effects of somatic treatments on suicidal ideation and completed suicides
Elise M Hawkins, William Coryell, Stephen Leung, Sagar V. Parikh, Cody Weston, Paul Nestadt, John I. Nurnberger Jr., Adam Kaplin, Anupama Kumar, Ali A. Farooqui, Rif S. El‐mallakh, For The National Network Of Depression Centers Suicide Prevention Task Group
Brain and Behavior November 25, 2021 Peer reviewed DOI: 10.1002/brb3.2381 via DOAJ
Summary
Lithium and clozapine are the only treatments with strong evidence showing they can reduce suicide risk in mood disorders and schizophrenia. While ketamine and esketamine might offer a small immediate antisuicide effect, there are concerns about increased suicide rates in patients receiving esketamine compared to placebo (3 vs. 0 among over 3500 subjects). Antidepressants may increase suicidal thoughts in young people in the short term, but their long-term effects on suicide risk remain unclear.
Study at a glance
| Design | literature review |
|---|---|
| Sample size | 3,500 |
| Population | patients receiving somatic treatments for mood disorders and schizophrenia |
| Key finding | Lithium and clozapine have high-quality data supporting their antisuicide effects, while the effects of antidepressants on suicide risk are ambiguous. |
Abstract
Abstract Objective This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide. Methods Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides. Results Lithium and clozapine are the only two somatic treatments that have high‐quality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk. Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low‐quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short‐term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. Conclusions Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.