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Antidepressants
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Short-term benefits are not clear; long-term effects are virtually untested
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Research findings are inconclusive. Suicidal risk may increase with agitation, and in youth but may be lower in older adults
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Studies lack long-term randomization with suicidal acts as an explicit outcome measure
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Antipsychotics
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Short-term benefits are not adequately tested. Clozapine is probably beneficial long-term in schizophrenia (with FDA approval) but untested in BD
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Except for clozapine, testing remains inadequate and inconclusive
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Effects of clozapine rely mainly on a single randomized trial vs. olanzapine, without reduction of mortality
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Anticonvulsants
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Short-term effects are not established; long-term benefits have been proposed
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Valproate most studied; anticonvulsants may be less effective than lithium
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Studies lack suicidal acts as an explicit outcome
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Lithium
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Very likely effective long-term
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Consistent decrease of risk of suicide and attempts in controlled and uncontrolled studies; not clear if effect is via reducing risk of depression, impulsivity, or specific anti-suicidal action
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Even randomized trials lack suicidal behavior as explicit outcome measure. Long-term acceptance and tolerance suggests some self-selection; potentially toxic on overdose
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Other pharmacological treatments
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Only short-term effects have been tested
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Ketamine can reduce suicidal ideation; effects on suicidal behavior are untested; newer NMDA agents untested
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Ketamine has a short-term antidepresant effect in BD
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Other somatic treatments
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If there are benefits, they are probably short-term
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ECT, magnetic, vagal nerve, or deep-brain stimulations can benefit depression
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Inadequate testing vs. suicidal behavior specifically
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Psychotherapies
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Effects not established, but widely assumed to be helpful clinically
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Cognitive-behavioral, dialectic and interpersonal methods best studied, but research results for suicide are inconclusive
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Psychotherapy involves self-selection
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