Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta‐analysis

• Published in: Depression and anxiety Vol. 39; no. 2; pp. 100 - 112
• 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 Hindawi Limited 01-02-2022
• Subjects: Adult; Antidepressants; Antimanic Agents - therapeutic use; Antipsychotics; Bipolar disorder; Bipolar Disorder - drug therapy; Clozapine; depression; Electroconvulsive therapy; Humans; Lithium; Lithium Compounds - therapeutic use; Magnetic fields; Mental depression; Meta-analysis; Placebos; Psychosis; Psychotropic drugs; Public health; Seizures; Suicide; Suicide - prevention & control; suicide/self harm; Suicides & suicide attempts; Systematic review; Transcranial Direct Current Stimulation; Transcranial magnetic stimulation; treatment; Vagus nerve; treatment; bipolar disorder; depression; suicide/self harm
• ISSN: 1091-4269; 1520-6394
• DOI: 10.1002/da.23222

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.