https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/wps.20994

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

https://doi.org/10.1016/j.euroneuro.2022.12.011

Prevention of suicide by clozapine in mental disorders: systematic review

Depressive disorders pose significant challenges to global public health, necessitating effective prevention and management strategies. Notably, the occurrence of suicide frequently coincides with depressive episodes. Suicide is as a paramount global health concern that demands efficacious preventive strategies. Current psychiatric approaches heavily rely on pharmacological interventions but have had limited success in addressing the global burden of mental health issues. Suboptimal nutrition, with its impact on the neuroendocrine system, has been implicated in the underlying pathology of depressive disorders. Folate, a group of water-soluble compounds, plays a crucial role in various central nervous system functions. Depressed individuals often exhibit low levels of serum and red blood cell folate. Multiple studies and systematic reviews have investigated the efficacy of folic acid and its derivative, L-methylfolate, which can cross the blood-brain barrier, as stand-alone or adjunct therapies for depression. Although findings have been mixed, the available evidence generally supports the use of these compounds in depressed individuals. Recent studies have established links between the one-carbon cycle, folate-homocysteine balance, immune system function, glutamate excitation via NMDA (N-methyl-D-aspartate) receptors, and gut microbiome eubiosis in mood regulation. These findings provide insights into the complex neurobiological mechanisms underlying the effects of folate and related compounds in depression. Through a comprehensive review of the existing literature, this study aims to advance our understanding of the therapeutic potential of folic acid and related compounds in depression treatment. It also seeks to explore their role in addressing suicidal tendencies and shed light on the neurobiological mechanisms involved, leveraging the latest discoveries in depression research.

Folate and Its Significance in Depressive Disorders and Suicidality: A Comprehensive Narrative Review.

Significance Against the backdrop of the current US mental health crisis, this study assembles 86 data sources to map, nationally, all psychiatrists and psychotherapists. Computationally modeling the relationship between access to mental health care providers and suicide, we find that improved spatial-social accessibility to psychiatrists and, to a lesser extent, to psychotherapists, is associated with reduced risk—even after controlling for a wide host of factors predictive of suicide. Locally, inequalities in mental health care access are additionally linked to substantially higher suicide risk. These findings demonstrate that nowadays, in the United States, access to mental health care is misaligned with need, and suggest that interventions to alleviate the access disparities currently impacting millions of Americans can prevent unnecessary death and suffering.

Differential spatial-social accessibility to mental health care and suicide

How to save a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide.

BACKGROUND Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. METHODS A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. RESULTS In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. CONCLUSION Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.

Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis.

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Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis.