Pharmacological Treatment of Suicidal Behavior

Abstract

Suicidal behaviour is mostly associated with psychiatric disorders. Nevertheless, people not meeting criteria of effective diagnostic systems can also be at great risk. If a psychiatric disorder is prevalent, treatment depends on the underlying disease. An integrative therapy consisting of pharmacological and non-pharmacological measures should always go beyond crisis intervention and acute treatment to prevent further suicidal behaviour. Regarding antidepressants, serotonin reuptake inhibitors (SSRIs) are the drugs of choice for most of the patients provided close observation and specific questioning of suicidality. Regarding the influence of other new antidepressants on suicidality only few data are available. Lithium treatment reduces the risk of suicide attempts and completed suicide significantly more than any other tested drug. It should be initiated early in the course of bipolar disorders and high-risk unipolar depressed patients. In the case of alcohol misuse and dependence, detoxification and withdrawal are most suitable to prevent suicidal behaviour, SSRIs or other antidepressants are used if depression persists or for co-morbid depression. Atypical neuroleptics, particularly clozapine, are effective in preventing suicidal behaviour in psychotic depression, schizophrenia and schizoaffective disorders. Special attention must be paid to the treatment of elderly patients as well as of children and adolescents at risk for suicidal behaviour. © 2005 S. Karger GmbH.