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Citation
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Focus (Am. Psychiatr. Publ.) 2023; 21(2): 197-208. |
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Abstract
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BACKGROUND: Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk.
METHODS: A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations.
RESULTS: In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] =.58, p =.005; k = 12) and compared to placebo/no lithium (OR =.46, p =.009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR =.27, p <.001; k = 12), but not compared to active controls (OR =.89, p =.468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR =.46, p =.007; k = 7). Associations between suicide death and electroconvulsive therapy (OR =.77, p =.053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR =.73, p =.090; k = 6) and antipsychotics in psychotic disorders (OR =.39, p =.069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation.
CONCLUSION: Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.
Language: en |