Prophylactic potential of selective reuptake inhibitors in suicidal patients.

Concentrations of cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) were similar in patients with major depressive disorder and in those with non-depressive psychiatric problems, although concentrations were significantly lower in suicidal patients (particularly in those attempters who used violent methods) than in non-suicidal patients. In contrast, post mortem CSF 5-HIAA concentrations in suicide victims were significantly higher than in controls. In addition, there appear to be fewer imipramine binding sites in the left frontal cortex of the brain than the right in suicide victims, the converse being true for controls. The serotonergic dysfunction associated with suicidal behaviour is likely to be involved in other conditions such as depression, schizophrenia and anxiety disorder. Thus selective serotonin reuptake inhibitors may be useful in the treatment of various types of psychiatric disease. Fluvoxamine, in particular, is associated with a very low incidence of suicidality compared with other antidepressants.