Emerging pharmacological and neuromodulation interventions for suicidal ideation and behaviour

Area of Science:

• Psychiatry and Neuroscience
• Pharmacology
• Neuromodulation

Background:

• Suicide is a major global health concern, with existing treatments often having slow onset or poor tolerability.
• There is a critical need for novel interventions targeting suicidal ideation (SI) and suicide attempts (SA) beyond current approved therapies.

Purpose of the Study:

• To review and summarize recent evidence on non-approved pharmacological and neuromodulation interventions for SI/SA over the past decade.
• To assess the efficacy and effectiveness of these emerging treatments in adult populations.

Main Methods:

• A structured literature search of PubMed was conducted for studies on adults with SI or SA.
• Included were controlled trials and naturalistic/observational studies examining pharmacological and neuromodulation interventions.
• Thirty-four studies were analyzed, comprising 22 pharmacological and 12 neuromodulation investigations.

Main Results:

• Pharmacological interventions, including NMDA-related drugs, buprenorphine, ayahuasca, and pimavanserin, showed encouraging results for SI reduction.
• Neuromodulation techniques like repetitive transcranial magnetic stimulation and magnetic seizure therapy demonstrated efficacy in reducing SI.
• Observational data suggested associations between certain medications (e.g., folic acid, oral anticoagulants) and reduced suicidality, while non-medical cannabis use was linked to worse outcomes.

Conclusions:

• Emerging pharmacological and neuromodulation treatments offer potential for faster reduction of suicidal ideation, sometimes independent of mood changes.
• Further research is needed to validate these findings, assess long-term durability, and optimize treatments for specific high-risk periods.
• Future trials should prioritize suicide-specific outcomes and investigate the independence of treatment effects from concurrent mood improvements.