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Citation |
Cheng-Ta Li, Ming-Been Lee. J. Suicidol. (Taipei) 2022; 17(1): 3-13. |
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Copyright |
(Copyright © 2022, Taiwanese Society of Suicidology, Publisher Airiti) |
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DOI |
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PMID |
unavailable |
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Abstract |
Suicide is a major public health issue and is highly associated with psychiatric disorders, especially with depression. The present paper aimed to review (1) suicidality, (2) pharmacological and neurostimulation treatments that have been approved by US Food and Drug Administration or have strong evidence to support their efficacy (i.e., a systemic review with at least 1 positive randomized placebo-controlled trial) in the treatment of suicidality, and (3) brain regions and circuits implicated in suicidality in patients with depression. Suicidality covers a broad range of terms, including suicidal ideations (SI), suicide attempts (SA), and even completed suicides (CS). Although SI predicted suicidal behaviors, less than 15% of people who experienced SI eventually attempted suicide. A growing number of evidence pinpoints neurobiological factors, in concert with psychosocial factors, play a critical role in serious suicidality. We found that lithium and clozapine have strong evidence to support antisuicidal effects in mood disordersand schizophrenia, respectively. In addition, electroconvulsive therapy has strong evidence to support its antisuicidal effect. Recent advances in the development of new somatic treatments, including low-dose ketamine, esketamine, buprenorphine, and repetitive transcranial magnetic stimulation (rTMS), provide a new hope for depressed individuals with SI. The dorsal prefrontal cortex (PFC) was evidenced to mediate SI to suicidal behaviors, while ventral PFC was more likely to be associated with processing negative emotion and stimulating SI. This review highlights the antisuicidal effects of these somatic treatments with their clinical positions and PFC as a key brain region involved in the suicidality-related circuits in patients with depression. Language: en |
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Keywords |
suicide; depression; buprenorphine; esketamine; low-dose ketamine; repetitive transcranial magnetic stimulation; somatic treatments |