From the Guidelines
Evidence-based treatments for actively suicidal patients should prioritize a combination of immediate safety measures, psychotherapy, and medication, with the first priority being ensuring patient safety through hospitalization or intensive outpatient monitoring, depending on risk level, as recommended by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1.
Key Components of Treatment
- Psychotherapy: Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) and Dialectical Behavior Therapy (DBT) have shown significant effectiveness in reducing suicidal ideation and behavior, typically delivered in weekly sessions over 3-6 months 1.
- Medication: Lithium (typically 600-1200mg daily with blood level monitoring) reduces suicide risk particularly in bipolar disorder, and clozapine (starting at 12.5mg and titrating up to 300-450mg daily) is effective for patients with schizophrenia 1.
- Ketamine: A single dose of 0.5mg/kg IV infusion has shown rapid anti-suicidal effects within hours, though effects may be temporary 1.
Non-Pharmacologic Interventions
- Crisis Response Planning: Involves a collaborative approach between patient and clinician to identify clear signs of crisis, self-management skills, and social support 1.
- Safety Planning: Essential component of treatment to reduce access to lethal means and provide a support network for the patient 1.
Importance of Regular Assessment
Regular assessment of suicidal ideation using standardized tools helps track progress and adjust treatment as needed, ensuring the effectiveness of interventions in addressing underlying psychological pain, hopelessness, and cognitive distortions that fuel suicidal thoughts 1.
From the Research
Evidence-Based Treatments for Actively Suicidal Patients
- The implementation of a suicide safety plan is a crucial tool in helping patients with suicidal urges, as it charts the course of action for the patient to follow when experiencing suicidal thoughts 2.
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, have been shown to be effective in reducing suicidality in adults, with some studies suggesting that they may lead to greater improvement and faster resolution of suicidal ideation compared to placebo 3, 4.
- A comprehensive proactive systems approach to treating suicidal patients in an inpatient setting, including formalized suicide assessment, accurate diagnosis, and best practice treatment, has been shown to be effective in preventing suicide 5.
- Combination therapy may be preferable to antidepressant monotherapy when beginning treatment, as it may reduce the risk of suicidal ideation and behavior 6.
- Monitoring for warning signs such as restlessness, ego-dystonic thoughts or urges, and impulsiveness is essential when treating patients with antidepressants, particularly selective serotonin reuptake inhibitors 6.
Key Considerations
- Risk-benefit analysis is crucial when prescribing SSRIs to patients, taking into account the potential treatment effects, adverse effects, and dangers of the illness being treated 4.
- Close monitoring of patients, particularly when starting or increasing antidepressant medication, is essential to detect potential suicidal ideation or behavior 6.