Reducing suicide risk in psychiatric disorders
Antidepressants show little protective effect in major depression, but more promising evidence is emerging for treating patients with bipolar or psychotic disorders.
Comparing two potentially effective agents may have limited the observed difference between clozapine and olanzapine.24 Nevertheless, previous (largely uncontrolled) comparisons with other treatment options indicate substantially lower risks of both suicides and attempts with clozapine.22 In December 2002, the FDA approved a unique indication for clozapine: to reduce the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.
Treatment recommendation. Risks of suicide and other causes of premature death are high in patients with chronic psychotic disorders, underlining the importance of appropriate longterm care. Clozapine has shown benefit in reducing risk of suicidal behaviors. When clozapine is otherwise a plausible option, this additional potential benefit can be considered when selecting therapy for individual patients.
Related resources
- American Psychiatric Association. Suicide-prevention practice guidelines. Washington, DC: American Psychiatric Press, 2003 (in press).
- American Foundation for Suicide Prevention. https://www.afsp.org
- American Association of Suicidology. www.suicidology.org
- National Institute of Mental Health (NIMH)/Suicide.
Drug brand names
- Clozapine • Clozaril
- Carbamazepine • Tegretol
- Divalproex • Depakote
- Haloperidol • Haldol
- Lithium carbonate • Eskalith, Lithobid, others
- Olanzapine • Zyprexa
Disclosure
Dr. Baldessarini has received research grants from Molecular Insight Pharmaceuticals, Eli Lilly and Co., Janssen Pharmaceutica, Protarga Inc., and Solvay Pharmaceuticals, and is a consultant to Auritec Laboratories, Molecular Insight Pharmaceuticals, Eli Lilly and Co., GlaxoSmithKline, Janssen Pharmaceutica, and Protarga Inc.
