Antidepressants |
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SSRI |
Adults with depression2626. Rucci P, Frank E, Scocco P, Calugi S, Miniati M, Fagiolini A, et al. Treatment-emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial. Depress Anxiety. 2011;28:303-9.,3030. Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. 2012;69:580-7.,3131. Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry. 2016;61:540-60. |
1 |
Close monitoring in the first 30 days of use, especially in adolescents. |
Venlafaxine |
Adults and geriatric patients with depression3030. Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. 2012;69:580-7.,3131. Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry. 2016;61:540-60. |
1 |
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Antipsychotics |
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Aripiprazole |
Depression with psychotic symptoms3232. Pompili M, Baldessarini RJ, Forte A, Erbuto D, Serafini G, Fiorillo A, et al. Do atypical antipsychotics have antisuicidal effects? A hypothesis-generating overview. Int J Mol Sci. 2016;17:1700. |
5 |
As adjunct to antidepressants. |
Clozapine |
Schizophrenia and schizophrenia-like psychoses3333. Lobos CA, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, et al. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev.2010(11):CD006633.,3434. Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis. Schizophr Res. 2005;73:139-45. |
1 |
Compared to olanzapine and other agents.3333. Lobos CA, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, et al. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev.2010(11):CD006633.,3434. Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis. Schizophr Res. 2005;73:139-45. |
Olanzapine |
Schizophrenia, schizoaffective, or schizophreniform disorder3232. Pompili M, Baldessarini RJ, Forte A, Erbuto D, Serafini G, Fiorillo A, et al. Do atypical antipsychotics have antisuicidal effects? A hypothesis-generating overview. Int J Mol Sci. 2016;17:1700. |
4 |
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Risperidone |
Schizophrenia, schizoaffective, or schizophreniform disorder3232. Pompili M, Baldessarini RJ, Forte A, Erbuto D, Serafini G, Fiorillo A, et al. Do atypical antipsychotics have antisuicidal effects? A hypothesis-generating overview. Int J Mol Sci. 2016;17:1700. |
4 |
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Quetiapine |
Bipolar depression3232. Pompili M, Baldessarini RJ, Forte A, Erbuto D, Serafini G, Fiorillo A, et al. Do atypical antipsychotics have antisuicidal effects? A hypothesis-generating overview. Int J Mol Sci. 2016;17:1700. |
4 |
As adjunct to lithium. |
Ketamine |
Bipolar disorder3535. Bartoli F, Riboldi I, Crocamo C, Di Brita C, Clerici M, Carra G. Ketamine as a rapid-acting agent for suicidal ideation: a meta-analysis. Neurosci Biobehav Rev. 2017;77:232-6.,3636. Grunebaum MF, Ellis SP, Keilp JG, Moitra VK, Cooper TB, Marver JE, et al. Ketamine versus midazolam in bipolar depression with suicidal thoughts: a pilot midazolam-controlled randomized clinical trial. Bipolar Disord. 2017;19:176-83. |
4 |
Experimental.Off-label use. |
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Major depressive disorder3737. Riblet NB, Shiner B, Young-Xu Y, Watts BV. Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. Br J Psychiatry. 2017;210:396-402.
38. Canuso CM, Singh JB, Fedgchin M, Alphs L, Lane R, Lim P, et al. Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: results of a double-blind, randomized, placebo-controlled study. Am J Psychiatry. 2018;175:620-30.
39. Chen MH, Lin WC, Wu HJ, Cheng CM, Li CT, Hong CJ, et al. Antisuicidal effect, BDNF Val66Met polymorphism, and low-dose ketamine infusion: reanalysis of adjunctive ketamine study of Taiwanese patients with treatment-resistant depression (AKSTP-TRD). J Affect Disord. 2019;251:162-9.-4040. Price RB, Iosifescu DV, Murrough JW, Chang LC, Al Jurdi RK, Iqbal SZ, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014;31:335-43. |
4 |
Not recommended for all cases. |
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Mood and anxiety spectrum disorders4141. Murrough JW, Soleimani L, DeWilde KE, Collins KS, Lapidus KA, Iacoviello BM, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45:3571-80. |
4 |
No evidence of sustained improvement. |
Lithium |
Bipolar disorder4242. Baldessarini RJ, Tondo L, Davis P, Pompili M, Goodwin FK, Hennen J. Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 2006;8:625-39. |
1 |
Therapeutic concentrations. Watch for side effects.Risk of use in suicide attempt. |
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Major depressive disorder4343. Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005;162:1805-19. |
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