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Prevention of suicide by Clozapine in mental disorders:: a systematic review

Prevention of suicide by Clozapine in mental disorders:: a systematic review
Prevention of suicide by Clozapine in mental disorders:: a systematic review

Background: Previous research has investigated the efficacy of clozapine in reducing suicidality in patients with schizophrenia and schizoaffective disorder. We aimed to systematically review published evidence, including studies concerning clozapine administration to treat: (a) refractory suicidality in other mental disorders, including bipolar disorder and borderline and other personality disorders; and (b) refractory cases of non-suicidal self-injury. Method: We performed a PUBMED-search (last day: July 17, 2022) of English-language studies, combining the keywords “clozapine”, “suicidality”, and “suicide” with various psychopathological terms (e.g. “schizophrenia”). All duplications were eliminated. Results: Fifty-one studies were eligible for inclusion in the review. Most studies suggest a superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder, compared to other antipsychotics, or no antipsychotic therapy, which is not due to the close monitoring of patients for blood dyscrasias. No consensus exists as to whether other antipsychotic drugs share this effect. Discontinuation of clozapine is associated with increases in suicidality. Reductions in refractory suicidality/NSSI are observed in clozapine-treated patients with bipolar disorder or borderline personality disorder, but the evidence is limited. Potential biological underpinnings of the anti-suicide effect of clozapine include its unique profile of modulation of brain neurotransmitters; its non-selectivity for neurotransmitter receptors; specific genetic and hormonal factors; effects on neuroinflammation; and ability to elicit epileptiform activity. Conclusion: The superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder patients is well established. It may have a role in severe and refractory cases of suicidality and non-suicidal self-injury in patients with bipolar disorder or borderline personality disorder, but the level and quality of supporting evidence is limited.

Clozapine, Self-injury, Suicidality, Suicide prevention
0924-977X
4-23
Masdrakis, Vasilios G.
ad0f0188-bdc2-4abb-9d17-0055cc006f99
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Masdrakis, Vasilios G.
ad0f0188-bdc2-4abb-9d17-0055cc006f99
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e

Masdrakis, Vasilios G. and Baldwin, David (2023) Prevention of suicide by Clozapine in mental disorders:: a systematic review. European Neuropsychopharmacology, 69, 4-23. (doi:10.1016/j.euroneuro.2022.12.011).

Record type: Review

Abstract

Background: Previous research has investigated the efficacy of clozapine in reducing suicidality in patients with schizophrenia and schizoaffective disorder. We aimed to systematically review published evidence, including studies concerning clozapine administration to treat: (a) refractory suicidality in other mental disorders, including bipolar disorder and borderline and other personality disorders; and (b) refractory cases of non-suicidal self-injury. Method: We performed a PUBMED-search (last day: July 17, 2022) of English-language studies, combining the keywords “clozapine”, “suicidality”, and “suicide” with various psychopathological terms (e.g. “schizophrenia”). All duplications were eliminated. Results: Fifty-one studies were eligible for inclusion in the review. Most studies suggest a superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder, compared to other antipsychotics, or no antipsychotic therapy, which is not due to the close monitoring of patients for blood dyscrasias. No consensus exists as to whether other antipsychotic drugs share this effect. Discontinuation of clozapine is associated with increases in suicidality. Reductions in refractory suicidality/NSSI are observed in clozapine-treated patients with bipolar disorder or borderline personality disorder, but the evidence is limited. Potential biological underpinnings of the anti-suicide effect of clozapine include its unique profile of modulation of brain neurotransmitters; its non-selectivity for neurotransmitter receptors; specific genetic and hormonal factors; effects on neuroinflammation; and ability to elicit epileptiform activity. Conclusion: The superior anti-suicide effect of clozapine in schizophrenia/schizoaffective disorder patients is well established. It may have a role in severe and refractory cases of suicidality and non-suicidal self-injury in patients with bipolar disorder or borderline personality disorder, but the level and quality of supporting evidence is limited.

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Accepted/In Press date: 27 December 2022
e-pub ahead of print date: 12 January 2023
Published date: 12 January 2023
Additional Information: Funding Information: None. Publisher Copyright: © 2022
Keywords: Clozapine, Self-injury, Suicidality, Suicide prevention

Identifiers

Local EPrints ID: 473887
URI: http://eprints.soton.ac.uk/id/eprint/473887
ISSN: 0924-977X
PURE UUID: 521a69fc-9243-4f1e-a390-1f44e22682cd
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 02 Feb 2023 17:39
Last modified: 15 Jul 2023 01:33

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Contributors

Author: Vasilios G. Masdrakis
Author: David Baldwin ORCID iD

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