Large-scale suicide prevention by pharmacological treatment of mood disorders

Abstract

IntroductionIn psychological autopsy studies, at least half of suicides have suffered from depressive or bipolar disorders at time of death. Improving access to care and provision of evidence-based pharmacotherapies can be important preventive measures.ObjectivesTo examine suicide risk and pharmacoepidemiology in mood disorders; evidence for efficacy of pharmacotherapies in mood disorders and in preventing suicidal behaviour in them, and limitations to effectiveness of treatment due to problems of adherence.AimsTo evaluate potentials for suicide prevention in mood disorders by improved access to treatment, improved quality of treatment provision, improved adherence, or by specific pharmacotherapies.MethodsSelective review of literature.ResultsRisk of suicide death and attempts in mood disorders clusters into major depressive and mixed illness episodes, and time spent in them is a major determinant of risk, but direct evidence for preventive effects of effective pharmacotherapies remains limited. Observational and randomized studies indicate lithium treatment to reduce risk of suicide deaths and attempts. Ecological evidence from Europe shows increasing sales of antidepressants to consistently associate with declining regional suicide rates. Forensic chemical studies still find majority suicides negative for antidepressants. Poor adherence is a central problem in treatment provision.ConclusionsPositive impact of increase in pharmacotherapy provision in the last few decades on suicide mortality remains uncertain. Lithium is the pharmacological agent with best evidence for preventive utility, but underused. Providing treatments for those at risk, improving quality and continuity of treatment, and integrating them with psychosocial approaches is likely to be beneficial for suicide prevention.Disclosure of interestThe author has not supplied his declaration of competing interest.