Mental Health: A Report by the Surgeon General

Psychopharmacological Treatments

There is a dearth of research on the efficacy of pharmacological treatments for reducing suicidal thoughts or preventing suicide in children and adolescents. Most of the research on pharmacotherapies has been conducted in adults. In depressed adults, SSRIs have been found to reduce suicidal ideation (Letizia et al., 1996; Wernicke et al., 1997) and to reduce the frequency of suicide attempts in nondepressed patients who had previously made at least one suicide attempt (Verkes et al., 1998). In a controlled trial of the experimental neuroleptic drug flupenthixol, researchers noted a significant reduction in suicide-attempt behavior in adults who had made numerous previous attempts (Montgomery & Montgomery, 1982). Similar studies have yet to be conducted on adolescents, although trials of SSRIs in depressed adolescents suggest that these drugs are effective for treating depression and for reducing suicidal ideas also in this age group (Emslie et al., 1997; Ryan & Varma, 1998). Because placebo-controlled, methodologically appropriate studies of tricyclic antidepressants have failed to find a significant effect in depressed children and adolescents (Ryan & Varma, 1998), it is reasonable to regard SSRIs as a first-choice medication in treating depressed suicidal children and adolescents (also see American Academy of Child and Adolescent Psychiatry, 1998). In contrast to tricyclic antidepressants, SSRIs have low lethal potential when taken in overdoses (Ryan & Varma, 1998).

In adults with major depressive disorder, controlled research suggests that lithium reduces suicide risk (Thies-Flechtner et al., 1996), but this has not yet been demonstrated in children and adolescents. Clinicians should be cautious about prescribing medications that may reduce self-control, such as the benzodiazapines, amphetamines, and phenobarbital. These drugs also have a high lethal potential if taken in overdose (Carlsten et al., 1996).

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