Current Status: Psychopharmacology for Suicide Prevention

Available with English captions and subtitles in Spanish.

Ross J. Baldessarini, MD, McLean Hospital, presents as part of the 2022 Suicide-Focused Assessment and Treatment: An Update for Professionals course.

Medications and Suicide Prevention

In this talk, Baldessarini reviews biomedical treatments, especially medications, known to impact suicidal thinking and behavior.

Medication’s role in addressing suicide is complicated and can depend on various factors, including a patient’s diagnosis and age.

Watch now to learn more about:

  • Why the role of psychopharmacology in preventing suicide is complex
  • How clozapine and lithium can reduce suicide in specific populations
  • How antidepressants may impact different age groups
  • Which new treatments are on the horizon

According to Baldessarini, “Biomedical approaches to therapeutics aimed at suicide prevention have been a difficult area for academic pursuit and have only been taken seriously for the past decade.”

He points out that a landmark in the area has been the use of clozapine in treating people with psychotic disorders. Research shows that the drug is clearly more effective than other modern antipsychotic drugs in preventing suicide.

However, clozapine’s effect on suicidality is only proven in people with schizophrenia and schizoaffective disorder. It needs to be further studied for people with bipolar disorder and other conditions.

Lithium is another treatment of interest. Baldessarini shares, “In looking at three dozen trials with over 3000 patients, mostly with bipolar disorder, the overall finding is again a huge reduction of suicidal behavior or risk with lithium versus alternative treatments.”

Baldessarini also addresses whether antidepressants provide benefits in preventing suicide.

Media coverage in recent years has focused on increased suicide risk in people under the age of 25 who took antidepressant medication.

View the Slides

According to Baldessarini, these research outcomes were of an increase in suicidal ideation, but not in fatalities. “In people above the age of 25, and particularly among those over 65, the risk of ideation was markedly decreased,” he states.

Ketamine is a newer treatment for severe, treatment-resistant depression.

“Suicidal thinking is diminished, as mood is improved very rapidly with ketamine,” Baldessarini states. “Within the first hours, first day, and possibly out to as long as three days, there is a clear and important reduction in suicidal ideation.”

He points out, however, that there are two issues with ketamine. First, there is still no evidence that it reduces suicidal behavior and suicidal outcomes. Second, it is not yet known if ketamine’s initial benefits on mood and suicidality can be maintained over the longer term.

Baldessarini concludes the talk by sharing very recent findings that folic acid supplements may play a role in preventing suicide.

“It is an epidemiologic finding—it is not based on a control trial, but it’s intriguing, and I hope that people will pursue it and look into it further.”


You may also find this information useful:

About Ross Baldessarini

Dr. Ross Baldessarini is the director of the International Consortium for Bipolar and Psychotic Disorders Research at McLean Hospital. He is also a tenured professor of psychiatry and neuroscience at Harvard Medical School and is widely regarded as having an unusually broad and critical perspective on the integration of basic research in neuroscience and pharmacology, with problems in clinical research and contemporary psychiatric practice.