Clozapine Found Most Likely of Common Antipsychotics to Reduce Risk of Suicide in Patients With Schizophrenia

Compared with other common antipsychotics, clozapine appears most likely to decrease the risk of suicidal outcomes in patients with schizophrenia, according to a report in Schizophrenia Bulletin.

The findings were based on two nationwide register-based cohort studies of 61,889 patients with schizophrenia who lived in Finland and 29,823 patients with schizophrenia who lived in Sweden. Heidi Taipale, Ph.D., of the University of Eastern Finland and colleagues specifically focused on patients who took the following first- or second-generation antipsychotics: clozapine, olanzapine, quetiapine, risperidone, risperidone (long-acting injectable), aripiprazole, perphenazine, zuclopenthixol (long-acting injectable), haloperidol, and levomepromazine. Each patient served as his or her control in the study, with the authors comparing suicide attempt/death during periods the patient was taking antipsychotics with periods the patient was not taking antipsychotics.

About 7% of the patients in the Finnish and Swedish cohorts attempted suicide or died by suicide during the study period.

“Compared with no use of antipsychotics, clozapine use was the only antipsychotic consistently associated with a decreased risk of suicidal outcomes in within-individual analyses,” the authors wrote. The risk for attempted or completed suicide was 36% lower when the patients in the Finnish cohort were taking clozapine and 34% lower when patients in the Swedish cohort were taking clozapine. “No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide,” they wrote. In contrast, patients who took adjunctive benzodiazepines and benzodiazepine-related Z-drugs were at an increased risk of attempted or completed suicide.

“Clozapine is the only pharmacological treatment associated with a substantially decreased risk of attempted or completed suicide [in patients with schizophrenia] and should be considered as first-line treatment for patients with suicidal ideation or behavior,” the authors concluded.

For related information, see the Psychiatric News article “The Appropriate Use of Medications in Suicidal Patients.”

(Image: iStock/FilippoBacci)

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