Experimental pharmacologic approaches for the reduction of suicidal ideation and behavior

Treatment of the suicidal patient is limited by existing antidepressant medications, which can take weeks for an adequate response. New treatment approaches associated with rapid reduction of acute suicide risk are greatly needed. Experimental therapeutics-including intravenous ketamine and scopolamine-have rapid, robust, and relatively sustained reductions in suicidal thoughts within minutes to hours of administration. These findings have the potential to transform emergent treatment of the acutely suicidal patient and implicate the glutamatergic and muscarinic system in the development of suicidal thoughts and behaviors. Other putative targets for antisuicidal intervention include the thyroid and purinergic system, the latter involving the impulsive/aggressive suicide endophenotype. Benefits of research involving rapid-acting therapeutics include smaller sample sizes, short length of clinical trials, and assured compliance with study interventions. This approach also permits the evaluation of possible biomarkers of response and relapse to be incorporated into clinical trial design to more rapidly identify neurobiological correlates of suicide risk.