Treatments for the Prevention and Management of Suicide

D’Anci, Kristen E.; Uhl, Stacey; Giradi, Gina; Martin, Constance

doi:10.7326/m19-0869

Cited by 130 publications

(81 citation statements)

References 22 publications

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“…Nevertheless, a population-based cohort study in Sweden clearly associated gabapentinoids, but not gabapentin, with an increased hazard of suicidal behavior [44]. Lithium has been shown in several meta-analyses to reduce suicidality [45][46][47]. One important mechanism of action for lithium is the blockade of GSK3β, which has many downstream targets including KCNQ2/3 [48].…”

Section: Discussionmentioning

confidence: 99%

Differential Dorsolateral Prefrontal Cortex Proteomic Profiles of Suicide Victims with Mood Disorders

Cabello-Arreola

Özerdem

et al. 2020

Genes

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Suicide is a major public health concern; nevertheless, its neurobiology remains unknown. An area of interest in suicide research is the dorsolateral prefrontal cortex (DLPFC). We aimed to identify altered proteins and potential biological pathways in the DLPFC of individuals who died by suicide employing mass spectrometry-based untargeted proteomics. Postmortem DLPFC from age-matched male suicide mood disorder cases (n = 5) and non-suicide mood disorder cases (n = 5) were compared. The proteins that differed between groups at false discovery rate (FDR) adjusted p-values (Benjamini–Hochberg–Yekutieli) <0.3 and Log2 fold change (FC) >|0.4| were considered statistically significant and were subjected to pathway analysis by Qiagen Ingenuity software. Thirty-three of the 5162 detected proteins showed significantly altered expression levels in the suicide cases and two of them after adjustment for body mass index. The top differentially expressed protein was potassium voltage-gated channel subfamily Q member 3 (KCNQ3) (Log2FC = −0.481, p = 2.10 × 10−09, FDR = 5.93 × 10−06), which also showed a trend to downregulation in Western blot (p = 0.045, Bonferroni adjusted p = 0.090). The most notably enriched pathway was the GABA receptor signaling pathway (p < 0.001). Here, we report a reduction trend of KCNQ3 levels in the DLPFC of male suicide victims with mood disorders. Further studies with a larger sample size and equal sex representation are needed.

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Section: Discussionmentioning

confidence: 99%

Differential Dorsolateral Prefrontal Cortex Proteomic Profiles of Suicide Victims with Mood Disorders

Cabello-Arreola

Özerdem

et al. 2020

Genes

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“…Nonetheless, suicides remain to be common soon after hospital discharge (Chung et al., 2017 ; Olfson et al., 2016 ). A multitude of protocols has been proposed as important for ensuring safety and reducing suicide risk, with varying success (D'Anci et al., 2019 ). Unfortunately, the recent increase in completed suicides (Goldstein et al., 2019 ; Hoffmire et al., 2015 ; Smith et al., 2019 ; Steelesmith et al., 2019 ) is evidence that we still have a long way to go.…”

Section: Introductionmentioning

confidence: 99%

“…Although depression is only one of the causes that leads to suicide, it is a major contributing factor in approximately half of completed suicides (Bachmann, 2018 ). For that reason, there is a particular focus on somatic interventions for depression as an indirect treatment for suicide ideation and prevention of suicide (D'Anci et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

“…Currently, suicidal ideation is treated through somatic interventions, such as medications and/or electroconvulsive therapy (ECT) (Fink et al., 2014 ), and psychosocial interventions, such as psychotherapy, most specifically cognitive behavioral therapy (CBT) (D'Anci et al., 2019 ). Pharmacologically, there is the potential for both positive and negative effects on suicides.…”

Section: Introductionmentioning

confidence: 99%

“…The effects antidepressants are controversial, but there is an association for more immediate increased risk for suicide with indirect evidence and a reduced risk over the lifetime (Brent, 2016 ). Medications such as lithium and clozapine have shown efficacy in lowering suicide bipolar patients and schizophrenia patients, respectively (D'Anci et al., 2019 ). However, lithium discontinuation may increase the risk for suicide (Baldessarini et al., 1999 ).…”

Section: Introductionmentioning

confidence: 99%

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Effects of somatic treatments on suicidal ideation and completed suicides

et al. 2021

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Objective: This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide.Methods: Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides.Results: Lithium and clozapine are the only two somatic treatments that have highquality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk.Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. Conclusions:Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.

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Suicide Prevention Research Priorities in Health Care

2020

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Suicide is an urgent, complex public health crisis. More than 48 000 people died by suicide in the United States in 2018, reflecting a rate that has increased by one-third over the past 2 decades. Despite these increases, we are optimistic that we can bend this curve. Along with the National Action Alliance for Suicide Prevention (NAASP), the National Institute of Mental Health (NIMH) is committed to reducing the suicide rate by 20% by 2025. This aspirational goal has guided our suicide prevention research agenda for the past 5 years, emphasizing risk detection, screening, and intervention in health care settings. In the next 5 years, the NIMH will prioritize research aimed at implementing evidence-based practices in routine care, filling critical knowledge gaps that will have a near-term effect on suicide rates, and engaging strategic partners to maximize the value of research findings. This effort is aligned with the US National Strategy for Suicide Prevention used by the NAASP that, among its objectives, seeks to transform health care systems to reduce suicide.To drive this research agenda, we are acting on research that indicates suicide prevention efforts in health care settings have the potential to significantly reduce suicide rates. Nearly 30% of decedents had a health care visit in the 7 days before suicide; half were seen in health care settings within the preceding 30 days; and around 90% had visits in the year before death. 1 Second, applying universal screening in the emergency care setting could double the number of individuals identified within usual care. 2 Similarly, the application of risk prediction algorithms to electronic health records can enhance prediction of suicide attempts and deaths, particularly when the data are enriched with screening information. 3 Third, there is a growing suite of effective interventions and care practices 4 that include medications and psychotherapies, a brief safety plan intervention, and follow-up efforts at high-risk, critical points of care transition such as "caring communication" contacts, and telephone calls to encourage ongoing social connection and care engagement. These practices can improve function and reduce the frequency of suicide attempts between 30% to 50% over the following year. The NAASP recommends that these practices be combined in a system of care and that health care organizations strive for this "Zero Suicide" approach. Researchers are working to address the challenges of implementing accountable (ie, electronic health record-based metrics), evidence-based care. 5 Building on existing prevention efforts, the NIMH has identified the following synergistic research priorities aimed at fielding evidence-based practices to address real-world implementation challenges and maximize near-term impact.

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Treatments for the Prevention and Management of Suicide

Cited by 130 publications

References 22 publications

Differential Dorsolateral Prefrontal Cortex Proteomic Profiles of Suicide Victims with Mood Disorders

Differential Dorsolateral Prefrontal Cortex Proteomic Profiles of Suicide Victims with Mood Disorders

Effects of somatic treatments on suicidal ideation and completed suicides

Suicide Prevention Research Priorities in Health Care

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