Suicidal behavior in mood disorders: Response to pharmacological treatment

Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with […]

Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study

Bipolar disorder (BPD) is associated with high rates of suicide attempts but the anti-suicidal effect of mood stabilizing agents remains unclear. This study aimed to examine the association between mood stabilizing agents (lithium, valproate, lamotrigine, carbamazepine or antipsychotics) and risk of suicide attempts in patients with BPD using self-controlled case series study design. Among 14,087 […]

Risks of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder treated with long-acting injectable or oral antipsychotics: A population-based retrospective cohort study in Taiwan

Background: Long-acting injectable (LAI) antipsychotics improve medication adherence in patients with schizophrenia and extend the duration of therapeutic drug levels but with administration of an increased dose. Real-world mortality data in patients prescribed LAIs are lacking. We conducted a population-based cohort study to estimate and compare the incidence rates of all-cause death and completed suicide […]

Comparative effectiveness of antipsychotics for risk of attempted or completed suicide among persons with schizophrenia

Objective The objective of our study was to investigate the comparative effectiveness of antipsychotics for the risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. Methods Two nationwide register-based cohort studies were conducted, including all individuals with schizophrenia in Finland (n = 61 889) and Sweden (n=29 823). The main […]

Subtypes of antipsychotics and suicidal behavior in bipolar disorder.

Objective: Antipsychotics are commonly used in bipolar disorder, with newer (SGA) agents increasingly replacing FGA antipsychotics, particularly in bipolar depression. There are few data on differences between FGA and SGA antipsychotics in terms of their relationship to suicidal behavior in bipolar disorder. Method: This was a retrospective chart review of 161 bipolar veterans treated naturalistically […]

A Canadian Naturalistic Study of a Community-Based Cohort Treated for Bipolar Disorder

This study compared the change in clinical parameters & resource utilization at 1 month in a group of 496 Canadian patients requiring treatment intervention for exacerbation of mania. The clinical response at 1 year was also evaluated. Patients were divided into the Olanzapine cohort, 287 patients, & the Other cohort, 209 patients who had a […]

Mortality in Schizophrenia: a Measurable Clinical Endpoint

A large number of retrospective epidemiological & prospective studies have been published on mortality rates & causation in schizophrenia, predominantly from 2006-2009. Data suggest the mortality gap with the general population increased from the 1970s but may have peaked in the mid-1990s. The main causes of mortality are suicide, cancer, & cardiovascular disease, with evidence […]

Suicidality in Schizophrenia: Pharmacologic Treatment

The use of antipsychotic, antidepressant, anxiolytic, & mood stabilizing drugs to reduce the risk of suicide in schizophrenia is reviewed. There is significant evidence from mirror image, registry, & one controlled trial indicating clozapine can greatly reduce the risk of a suicide attempt, & most likely completed suicide, in patients with schizophrenia or schizoaffective disorder. […]

Management of Schizophrenia With Suicide Risk

The management of schizophrenic patients with suicide risk remains a difficult area for clinicians despite attempts to understand it better by gathering experts in the field. The aim of this article is to provide an overview with a specific focus on the management of schizophrenia with suicide risk. Management strategies discussed include: the recognition of […]

Efficacy of Risperidone Augmentation to Antidepressants in the Management of Suicidality in Major Depressive Disorder: a Randomized, Double-Blind, Placebo-Controlled Pilot Study

24 adult men & women diagnosed with major depressive disorder, having a depressive episode with suicidality despite taking an antidepressant, were enrolled in an 8-week double-blind, placebo-controlled study. Subjects were randomly assigned to receive risperidone or placebo while continuing their antidepressant therapy. Clinical efficacy in suicidality, depressive symptoms, & impulsivity were assessed after 4 days, […]

Patterns of Concomitant Psychotropic Medication use During a 2-Year Study Comparing Clozapine and Olanzapine for the Prevention of Suicidal Behavior

In this study, 479 patients received clozapine & 477 patients received olanzapine. Concomitant psychotropic medications were grouped into 4 classes: antipsychotics, antidepressants, sedatives/anxiolytics, & mood stabilizers. An analysis of covariance was performed to compare mean daily doses of concomitant psychotropic medications between the 2 groups over the 2-year treatment period. For each class, the mean […]

Reduced Suicidal Ideation in Bipolar I Disorder Mixed-Episode Patients in a Placebo-Controlled Trial of Olanzapine Combined With Lithium or Divalproex

Symptoms associated with suicidality in bipolar I patients were identified & suicide risk during treatment with olanzapine in combination with lithium or divalproex was assessed. Data were used from a previous study in which patients with bipolar I manic or mixed-episode who were partially responsive to at least 2 weeks of lithium or divalproex monotherapy […]

Ethnic Differences in Antidepressant Treatment Preceding Suicide in Sweden


Reducing Suicide Risk in Psychiatric Disorders

Suicide is the leading cause of malpractice liability in psychiatry & of the heightened risk of death in persons with major affective & psychotic disorders. This article provides the latest findings to help clinicians choose medications for at-risk patients with bipolar disorder, major depression, or chronic psychoses. (25 refs.)

Quetiapine Adjunct to Selective Serotonin Reuptake Inhibitors or Venlafaxine in Patients With Major Depression, Comorbid Anxiety, and Residual Depressive Symptoms: a Randomized, Placebo-Controlled Pilot Study

This double-blind, placebo-controlled study examined the efficacy & tolerability of quetiapine in combination with selective serotonin reuptake inhibitors/venlafaxine in 58 patients with major depressive disorder, comorbid anxiety symptoms, & residual depressive symptoms. Significant differences from baseline to Week 8 of treatment were observed between groups in 7 of 17 Hamilton Depression Scale items, including feelings […]

Epidemiology, Risk Factors, and Psychopharmacological Management of Suicidal Behavior in Borderline Personality Disorder

Borderline personality disorder is a chronic psychiatric condition characterized by a pervasive pattern of instability in affect regulation & impulse control. These maladaptive coping strategies predispose individuals with borderline personality disorder to suicidal behaviour & this diagnosis increases the risk for completed suicide. Psychopharmacological interventions, including the use of antidepressants, anti-psychotics, & mood stabilizers, are […]

Psychopharmacologic Management of Suicidality in Personality Disorders

To review the evidence for the efficacy of pharmacotherapy and other biological treatments in suicidality associated with personality disorders, chiefly borderline personality disorder. Systematic review of the literature. Studies evaluating treatment of suicidality in personality disorders are absent. However, several studies examine the efficacy of pharmacotherapy for core symptom clusters that are closely associated with […]

Treatment of Suicidality in Schizophrenia

This article includes a discussion between J Mann and H y Meltzer.

The International Suicide Prevetion Trial (InterSePT): Rationale and Design of a Trial Comparing the Relative Ability of Clozapine and Olanzapine to Reduce Suicidal Behavior in Schizophrenia and Schizoaffective Patients

Suicidal behavior in patients with psychotic disorders represents a seriously undertreated life-threatening condition. The International Suicide Prevention Trial (InterSePT) is the first large-scale, prospective study designed to evaluate the potential of antipsychotic medications to reduce suicidal behaviors in patients with schizophrenia or schizoaffective disorder who are known to be at high risk for suicide. The […]

Estimating Suicidality as an Outcome Measure in Clinical Trials of Suicide in Schizophrenia

A Suicide Monitoring Board (SMB) evaluated putative events of suicidal behavior to determine whether they should be counted as outcome data (endpoints) in the International Suicide Prevention Trial (InterSePT) study. The InterSePT study compared clozapine and olanzapine prospectively, on reduction of suicidality in schizophrenia and schizoaffective disorder. SMB members, blinded to patient identification, evaluated packages […]

Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of Patients in Community Care After First Hospitalisation due to Schizophrenia and Schizoaffective Disorder: Observational Follow-up Study


Antipsychotic Drugs in Bipolar Disorder

This article reviews the use of antipsychotic drugs in the treatment of acute mania & as maintenance treatment. The evidence for the use of atypical antipsychotic drugs, including their effects on suicidal behaviours, is discussed. Clozapine, risperidone, olanzapine, & other atypic antipsychotics are reviewed. (59 refs.)

Strategies to Prevent Suicide

These letters to the editor comment on a previous article by Mann et al (2005) on suicide prevention strategies. Tondo & Baldessarini note the lack of discussion of disorders other than major depression & treatments other than antidepressants. Knox & Caine provide more information on the Air Force Suicide Prevention Program, disputing Mann et al’s […]