Effect of pharmacotherapy on suicidal ideation and behavior

Abstract

AbstractSuicide has become an important public health issue. It is the eighth leading cause of death among adults and varies between the second and third leading cause of death for youth under the age of 24 years. Suicidal ideation is a common symptom of psychiatric disorders; over 55% of individuals with mental disorders report suicidal ideation at some point in their lives. Fully 25% of individuals with mental disorders make at least one lifetime suicide attempt and over 12% make multiple suicide attempts. Suicidal ideation and suicidal acts are most prevalent in individuals with mood disorders. Almost 17% of individuals with either major depression or dysthymia make at least one suicide attempt while over 28% of individuals with bipolar disorders attempt suicide. Intensification of suicidal thoughts and behavior can occur in depressed patients undergoing active treatment, including antidepressant pharmacotherapy, and the risk may persist until remission occurs. Within this context, it is likely that reports linking the SSRI fluoxetine (and other antidepressants) with intensification of suicidal ideation represent random occurrences rather than causation. Although it is possible that some type of aberration in CNS serotonergic function in rare individuals might be associated with an idiosyncratic response to serotonin‐specific medications, the retrospective meta‐analyses of a number of databases indicate there is no causal relationship between SSRI or other antidepressant medication treatment and the emergence of suicidal ideation or behavior. Rather, the available data support the conclusion that antidepressant pharmacotherapy diminishes suicidal ideation and acts. Depression 2:169–172 (1994/1995). © 1995 Wiley‐Liss, Inc.