Citation

Zuschlag ZD. J. Clin. Psychiatry 2021; 82(5).

Copyright

(Copyright © 2021, Physicians Postgraduate Press)

DOI

10.4088/JCP.21ac13955

PMID

unavailable

Abstract

More than 48,000 people in the United States die of suicide per year.1 Suicide rates are progressively rising,2 and recent research has identified that suicide rates are consistently underreported,3 further highlighting the need for interventions to reduce suicide. There are robust data showing the potential suicide reducing properties of lithium4 and clozapine,5 the latter being the only medication with an FDA indication for reducing suicidal behaviors; however, literature on the suicide reducing effects of other pharmacologic agents is less clear. Second-generation antipsychotics (SGAs) are of particular interest, as early research showed promising results for potential associations with decreased suicide. However, further research on the effects of non-clozapine SGAs on suicidality has shown mixed results. Additionally, due to methodological difficulties, prospective controlled trials directly examining the effects of medications on suicidality are limited, and thus much of the data on the effects of SGAs on suicide has been obtained from retrospective cohort studies and epidemiologic data such as population based cross-sectional studies. The results of such research can be difficult for clinicians to interpret for implementation into clinical practice. Thus, a targeted literature review was conducted, and a summarizing commentary is presented in an effort to clarify the effects of non-clozapine SGAs on suicide, including both suicidal ideations and suicidal behaviors.

Initial studies examining SGAs showed promising results for suicide reducing effects, including an early randomized controlled trial (RCT) of the SGA olanzapine compared to the first-generation antipsychotic haloperidol, which found a 2.3-fold decrease in suicide attempts in individuals on olanzapine.6 Since that time, a number of retrospective case control and population based cross-sectional studies have shown evidence for an association between SGAs and decreased suicidality. These include a retrospective case control cohort which found that SGAs were associated with a 3.54 times reduction in attempted suicide7; an epidemiologic study that showed individuals with schizophrenia who discontinued/interrupted treatment with an SGA were 4 times more likely to attempt suicide than those who remained on SGAs8; a retrospective cohort study which found that individuals prescribed SGAs were less likely to attempt suicide than those on first-generation antipsychotics9; and a large case-control study which found that individuals treated with an SGA had a 71% lower risk of death by suicide than individuals not treated with SGAs...

Language: en