Do Atypical Antipsychotics Have Antisuicidal Effects? A Hypothesis-Generating Overview

Abstract

Modern antipsychotic drugs are employed increasingly in the treatment of mood disorders as well as psychoses, stimulating interest in their possible contributions to altering suicidal risk. Clozapine remains the only treatment with an FDA-recognized indication for reducing suicidal risk (in schizophrenia). We carried out a systematic, computerized search for reports of studies involving antipsychotic drug treatment and suicidal behaviors. A total of 19 reports provide data with preliminary support for potential suicide risk-reducing effects of olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in addition to clozapine, and provide some support for antipsychotic drug treatment in general. These preliminary findings encourage further testing of antipsychotics for effects on suicidal behavior, making use of explicit, pre-planned assessments of suicidal behavior.

Bipolar depression: a major unsolved challenge

“…In effective doses, antipsychotics risk adverse effects that include excessive sedation as well as distressing restlessness (akathisia) (Brown et al 2006;Tamayo et al 2010). Although risks of tardive dyskinesia with most SGAs are far lower than with FGAs (Tarsy et al 2010;Carbon et al 2017), their greatly increasing use and broadening indications may risk increased numbers of cases of even this uncommon adverse outcome (Pompili et al 2016). Moreover, risks of weight-gain, type-2 diabetes, and other features of metabolic syndrome (hyperlipidemia, hypertension) are encountered with some SGAs (particularly olanzapine and quetiapine), sometimes rapidly (Centorrino et al 2012;Baldessarini 2013;Vázquez et al 2015).…”

Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome

“…Patient’s insight, which is a factor that protects from relapses and recurrences, has been considered a major factor for suicide in schizophrenia [ 96 ]. Gradual gains in insight brought by successful AAP treatment may decrease suicidal risk [ 96 , 97 ]. However, it is unclear whether most atypical antipsychotics are directly effective in preventing suicide [ 98 ].…”

Clozapine in Treatment-Resistant Bipolar Disorder With Suicidality. Three Case Reports

“…According to Youssef, pregnenolone alterations may be relevant to the neurobiology of suicide in schizophrenia and BD and may constitute a common path for the anti-suicidal effect for clozapine and lithium (28). There are few interesting studies suggesting that newer atypical antipsychotics like quetiapine and asenapine could also reduce suicidal ideation in BD, and they, just like clozapine, should definitely be studied further (29).…”