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Neurosci Biobehav Rev. 2013 Dec;37(10 Pt 1):2398-403. doi: 10.1016/j.neubiorev.2012.09.009. Epub 2012 Sep 27.

Pharmacological prevention of suicide in patients with major mood disorders.

Author information

1
Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6., 1083 Budapest, Hungary.

Abstract

The risk of self-destructive behavior in mood disorders is an inherent phenomenon and suicidal behavior in patients with unipolar or bipolar major mood disorders strongly relates to the presence and severity of depressive episodes. Consequently, early recognition, and successful acute and long-term treatment of depressive disorders is essential for suicide prevention in such patients. Large-scale, retrospective and prospective naturalistic long-term clinical studies, including severely ill, frequently suicidal depressives show that appropriate pharmacotherapy markedly reduces suicide morbidity and mortality even in this high-risk population. Supplementary psycho-social interventions further improve the effect. The slightly elevated (but in absolute sense quite low) risk of suicidal behavior among patients taking antidepressants compared to those taking placebo in randomized controlled antidepressant trials on unipolar major depression might be the consequence of the depression-worsening potential of antidepressant monotherapy in subthreshold and mixed bipolar depressed patients included in these trials and falsely diagnosed as suffering from unipolar major depression. Concurrent depression-focused psychotherapies increase the effectiveness of pharmacotherapy and this way contribute to suicide prevention for patients with mood disorders.

KEYWORDS:

Antidepressants; Bipolar disorder; Completed suicide; DSM-IV; Diagnostic and Statistical Manual of Mental Disorders; ECT; FDA; Food and Drug Administration; OR; RCT; SSRI; Suicide attempt; Suicide prevention; TCA; Unipolar major depression; electroconvulsive therapy; odds ratio; randomized controlled trial; selective serotonin reuptake inhibitors; tricyclic antidepressant

PMID:
23022665
DOI:
10.1016/j.neubiorev.2012.09.009
[Indexed for MEDLINE]

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