CHRU Montpellier, Inserm U888, Hôpital La Colombière, Pavillon 42 39 av. Charles Flahault, University of Montpellier I, Montpellier, France.
Neuropsychiatr Dis Treat. 2010 Sep 7;6(Suppl I):3-8. doi: 10.2147/NDT.S11774.
Suicidal behavior (SB) represents a major public health issue. Clinical and basic research suggests that SB is a specific entity in psychiatric nosology involving a combination of personality traits, genetic factors, childhood abuse and neuroanatomical abnormalities. The principal risk factor for suicide is depression. More than 60% of patients who complete suicide are depressed at the time of suicide, most of them untreated. There has been a controversy concerning a possible increased risk of SB in some depressed patients treated with antidepressants. Most recent evidence suggests, however, that treatment of depressed patients is associated with a favorable benefit-risk ratio. A recent study has determined the effects of 6 weeks of antidepressant treatment with the serotonin and norepinephrine reuptake inhibitor, milnacipran, on suicidality in a cohort of 30 patients with mild to moderate depression. At baseline, mild suicidal thoughts were present in 46.7% of patients. Suicidal thoughts decreased progressively throughout the study in parallel with other depressive symptoms and were essentially absent at the end of the study. At no time during treatment was there any indication of an increased suicidal risk. Retardation and psychic anxiety decreased in parallel possibly explaining the lack of any "activation syndrome" in this study.
自杀行为（SB）是一个主要的公共卫生问题。临床和基础研究表明，SB 是精神病学分类中的一种特定实体，涉及人格特质、遗传因素、儿童期虐待和神经解剖异常的组合。自杀的主要危险因素是抑郁症。在自杀时，超过 60%的完成自杀的患者患有抑郁症，其中大多数未得到治疗。有人争论说，一些接受抗抑郁药治疗的抑郁症患者可能存在自杀风险增加的问题。然而，最新证据表明，治疗抑郁症患者与有利的风险效益比相关。最近的一项研究确定了 6 周的抗抑郁药治疗对 30 名轻度至中度抑郁症患者的自杀意念的影响，使用的是 5-羟色胺和去甲肾上腺素再摄取抑制剂米那普仑。在基线时，46.7%的患者存在轻度自杀念头。自杀念头在整个研究过程中逐渐减少，与其他抑郁症状平行，并在研究结束时基本消失。在治疗过程中的任何时候都没有任何迹象表明自杀风险增加。迟缓和精神焦虑平行下降，这可能解释了在这项研究中没有出现任何“激活综合征”。
