Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6., 1083 Budapest, Hungary.
Neurosci Biobehav Rev. 2013 Dec;37(10 Pt 1):2398-403. doi: 10.1016/j.neubiorev.2012.09.009. Epub 2012 Sep 27.
The risk of self-destructive behavior in mood disorders is an inherent phenomenon and suicidal behavior in patients with unipolar or bipolar major mood disorders strongly relates to the presence and severity of depressive episodes. Consequently, early recognition, and successful acute and long-term treatment of depressive disorders is essential for suicide prevention in such patients. Large-scale, retrospective and prospective naturalistic long-term clinical studies, including severely ill, frequently suicidal depressives show that appropriate pharmacotherapy markedly reduces suicide morbidity and mortality even in this high-risk population. Supplementary psycho-social interventions further improve the effect. The slightly elevated (but in absolute sense quite low) risk of suicidal behavior among patients taking antidepressants compared to those taking placebo in randomized controlled antidepressant trials on unipolar major depression might be the consequence of the depression-worsening potential of antidepressant monotherapy in subthreshold and mixed bipolar depressed patients included in these trials and falsely diagnosed as suffering from unipolar major depression. Concurrent depression-focused psychotherapies increase the effectiveness of pharmacotherapy and this way contribute to suicide prevention for patients with mood disorders.
心境障碍患者的自伤行为风险是一种固有现象，单相或双相重性抑郁障碍患者的自杀行为与抑郁发作的存在和严重程度密切相关。因此，早期识别和成功治疗抑郁障碍对于预防此类患者的自杀至关重要。大规模、回顾性和前瞻性自然主义长期临床研究，包括病情严重、经常自杀的抑郁症患者，表明适当的药物治疗可显著降低自杀发病率和死亡率，即使在高危人群中也是如此。补充心理社会干预进一步提高了疗效。与随机对照抗抑郁药治疗单相重性抑郁的安慰剂相比，抗抑郁药治疗单相重性抑郁的患者自杀行为风险略有升高（但从绝对值来看相当低），这可能是由于这些试验中包括的亚阈值和混合双相抑郁患者的抗抑郁药单药治疗有加重抑郁的潜在风险，这些患者被错误地诊断为单相重性抑郁。同时进行以抑郁为重点的心理治疗可提高药物治疗的效果，从而有助于预防心境障碍患者的自杀。
