The clean and dirty ways to reduce suicidality

Abstract

Many psychiatric disorders, including depression, bipolar disorder, schizophrenia, and alcohol use disorder, are characterized by an increased suicidal risk. Successful treatment of mental disorders with the use of antidepressants, antipsychotics, and mood stabilizers can reduce the risk of associated suicidality: suicidal thoughts, suicide attempts, and completed suicides. Clozapine and lithium have an outstanding ability to reduce the probability of suicide, and their common property, which determines (along with other pharmacological effects) their antisuicidal potential, is the reduction of impulsivity and aggression. In addition to significant antisuicidal activity, clozapine and lithium are characterized by both an advantage in overall clinical efficacy over other drugs of their classes, and significant risk of side effects, as well as complications of therapy.