Suicide is a devastating, tragically frequent outcome for persons with varying psychiatric conditions, including schizophrenia. An estimated 5% to 10% of persons with schizophrenia commit suicide and 20% to 50% attempt suicide during their lifetime.1,2 Patients with schizophrenia have more than an 8-fold increased risk of completing suicide (based on the standardized mortality ratio) than the general population.3 Antipsychotic treatment is the cornerstone of the therapeutic approach to schizophrenia and has been thought to influence suicidal tendencies.4 Yet, both typical and atypical antipsychotics (the latter of which have been considered to have a better profile for reducing the risk of suicide than the former) have not been shown to have a net positive effect on suicidality.5,6
Atypical antipsychotics are now considered to be a first-line treatment for schizophrenia. It is therefore crucial that we have an evidence-based approach to minimizing suicidal thinking and behavior. We have recently reviewed the relationship between antipsychotic drugs and suicide in patients with schizophrenia, observing that many inconsistencies exist among the studies. This, in turn, prevents any definitive conclusions; the sole exception is clozapine, which should be considered when suicide risk is detected.7
This article reviews the evidence for the various atypical antipsychotics in potentially reducing the risk of suicide in patients with schizophrenia. A high degree of efficacy should not be expected, since 2 large reviews on premarketing data have failed to demonstrate the efficacy of atypical antipsychotics (excluding clozapine) in reducing the risk of suicidality in patients with schizophrenia.8,9 Further limitations come from methodological issues, which may be seen in some studies that originate within the pharmaceutical industry.10
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