A synthesis of current findings regarding neurobiological correlates and treatment of suicidal behavior.

Considerable progress has been made in the study of neurobiological correlates of suicidal behavior. These studies have confirmed the link between reduced serotonergic function and serious suicidal acts. They have localized the changes to the ventral prefrontal cortex and suggested how genetics, childhood rearing, alcoholism, substance abuse, gender, age, and cholesterol intake can modulate suicide rates through effects on the serotonergic system. Future studies need to apply this knowledge in the development of in vivo brain imaging and molecular genetic probes for study of high-risk patients. Identification of high-risk groups is essential for the conduct of controlled treatment trials, which are presently almost entirely lacking in suicidal populations. Previous clinical trials of medications and psychotherapies have targeted axis I or axis II disorders but not the predisposition to suicidal acts. Controlled treatment in high-risk patients must be undertaken to identify interventions that can reduce the propensity for suicidal acts. Such interventions will supplement current treatment strategies that target the associated psychiatric illness and reduce the opportunities to attempt suicide in high-risk patients by hospitalization.