OBJECTIVE: Suicidal
behavior has been associated with reduced central serotonergic
function. Because selective serotonin reuptake inhibitors (SSRIs) enhance
serotonergic function, the authors studied the efficacy of an SSRI,
paroxetine, in the prevention of recurrent suicidal behavior.
METHOD: They conducted a 1-year
double-blind study comparing paroxetine (40 mg/day) and placebo in 91
patients who had recently attempted suicide for at least a second time. None
of the patients had experienced a major depressive episode or had any other
major DSM-III-R axis I diagnoses. At least one cluster B personality
disorder was present in 74 patients.
RESULTS: With adjustment for the number
of previous suicide attempts, paroxetine showed significant efficacy in the
prevention of recurrent suicidal behavior. Among the patients who had
attempted suicide fewer than five times, 12 (36%) in the placebo group (N =
33) and five (17%) in the paroxetine group (N = 30) made a subsequent
suicide attempt. Paroxetine was also significantly more effective in
patients who met fewer than 15 criteria for cluster B personality disorders
than in those who met more than 15 criteria. Overall, paroxetine was not
significantly different from placebo in its effect on depressive mood,
hopelessness, and anger. However, the data suggest that paroxetine may have
some temporary effect in reducing anger.
CONCLUSIONS: This study indicates that
enhancing serotonergic function with an SSRI may reduce suicidal behavior in
a subgroup of patients who have attempted suicide more than once but who do
not suffer from major depression.