Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis

• Published in: Focus (American Psychiatric Publishing) Vol. 21; no. 2; pp. 197 - 208
• Main Authors: Wilkinson, Samuel T., Trujillo Diaz, Daniel, Rupp, Zachary W., Kidambi, Anubhav, Ramirez, Karina L., Flores, José M., Avila‐Quintero, Victor J., Rhee, T. Greg, Olfson, Mark, Bloch, Michael H.
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01-04-2023
• Subjects: Influential Publications; treatment; bipolar disorder; depression; suicide/self harm
• ISSN: 1541-4094; 1541-4108
• DOI: 10.1176/appi.focus.23021006

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