The prevention of recurrent suicidal acts

Area of Science:

• Psychiatry
• Clinical Psychology
• Pharmacology

Background:

• Controlled prospective studies on preventing suicidal behavior are limited.
• Previous interventions like social work, psychotherapy, and psychiatric treatment have largely failed to demonstrate efficacy.

Purpose of the Study:

• To investigate the efficacy of mianserin, an antidepressant, in reducing suicidal behavior in high-risk patients.
• To identify predictors of suicidal behavior in patients with personality disorders.

Main Methods:

• A six-month, double-blind trial involving 58 high-risk patients with recurrent suicidal behavior.
• Patients received either mianserin (30 mg nightly) or a placebo.
• Screening for depression, schizophrenia, organic disease, and personality disorders (DSM-III criteria).

Main Results:

• No significant difference in outcome was observed between the mianserin and placebo groups.
• At baseline, 'reduced appetite' predicted subsequent suicidal attempts.
• At four weeks, 'reduced sleep' and 'reduced appetite' were significant predictors of further suicidal acts, alongside 'lassitude', 'suicidal thoughts', 'inability to feel', and 'pessimistic thoughts' on the MADRS scale.

Conclusions:

• Mianserin at 30 mg nightly did not prove effective in preventing suicidal behavior in this high-risk population.
• Specific baseline and four-week symptom ratings on the MADRS scale can predict future suicidal acts, offering potential targets for intervention.