APA's Guidelines on Suicide Hail Antidepressant Tx: More Than 34,000 Studies Were Weighed, Researched to Formulate New Approaches

Article excerpt

The American Psychiatric Association's first comprehensive practice guidelines on suicide are the product of years of research and exhaustive debate among experts on the committee and eight professional organizations.

More than 34,000 scientific studies were reviewed and weighed based on their methodology and scientific merit.

"There's a lot in there to absorb," said Dr. Douglas G. Jacobs, who chaired the expert work group that developed the document. "Psychiatrists may want to look at different sections as they struggle with patients with different disorders."

The guidelines, at 117 pages--including 846 references--focus on evidence-based justification for several approaches to suicide assessment and treatment of patients with suicidal ideation or intent.

Dr. James H. Scully Jr., medical director of the APA, called the new guidelines "a major contribution to the field."

They are meant to be practical and useful, guiding assessment and treatment decisions with evidence, not just consensus within the field, Dr. Jacobs, who is executive director of the nonprofit organization Screening for Mental Health in Wellesley Hills, Mass., stressed during a telephone interview.

Antidepressants are hailed as a mainstay of depression therapy, although the evidence demonstrating their reduction of suicide risk has not yet been produced.

"Since suicidal behavior is strongly associated with depressive illnesses and some forms of anxiety, treatment with antidepressants should plausibly be associated with reduced suicide rates.

However, the available evidence remains surprisingly inconclusive that any type of antidepressant or antianxiety treatment is associated with lowering of risk for suicidal behavior," the guidelines note.

Use of lithium for patients with recurrent major affective disorders, on the other hand, is supported "by the strongest available evidence of major reductions in suicide risk of any currently employed psychiatric treatment," the guidelines state.

The antipsychotic drug clozapine (Clozaril), approved by the Food and Drug Administration for use in suicidal patients a little more than a year ago, also merited favorable mention in the new guidelines. Despite its risk of side effects, clozapine has been "by far" the best studied among all antipsychotics for specific behaviors related to suicide, with favorable results.

Electroconvulsive therapy was cited for its "rapid and robust" antidepressant effects, but committee members noted the lack of evidence for any long-term protective effect. …