The Unexamined Life

Scientists Debate On What Causes Suicide Attempts

Treatment and prevention of suicide have long been an unsolvable medical crisis since drugs are scarce and psychologists themselves are in a quandary over the right remedies to recommend. Currently, clozapine is the only medication prescribed by the Food and Drug Administration (FDA) for suicide prevention in schizophrenics, particularly. For mood disorders, the FDA suggests antipsychotics lithium and antidepressants.

Leading up to National Mental Health Month in May, the New York Times published an opinion piece titled “The Empty Promise of Suicide Prevention” late last month. In the piece, psychiatrist Amy Barnhorst, vice chair of community mental health at University of California, Davis, brought up the two schools of thought espoused by practitioners in the field. The first one being that taking antidepressants brings down suicidal risk significantly and, contrariwise, medication cannot fix the circumstances determining a person’s suicidal ideation.    

Barnhorst sided with the latter and put her views forward with a few examples taken from her medical practice. A middle-aged homeless woman who was recently assaulted had overdosed on ibuprofen, despite not having a previous record of mental illness. Owing to the lack of financial and familial support, she decided to end her life.

This incident is similar to the findings of a study based on the responses of patients occupying emergency rooms at seven university hospitals in South Korea. The study stated that 48 percent of the 269 patients who were confirmed to have made impulsive suicidal attempts had developed sudden inclinations to go through with the act.

Younger, unmarried and the more physically fit patients had displayed these impulsive urges surprisingly. Also, the ideation prior to attempting suicide was not as intense when compared to the ideas fleshed out by the non-impulsive ones. Another study quoted by the NYT report suggested that “inadequate control of aggressive impulses might be a greater indicator of risk for impulsive suicide attempts than depression.”

Suicide A stuffed toy monkey is seen on railway tracks at Watford Junction in England on April 8, 2007. Flickr/Creative Commons/Jason Rogers

According to Barnhorst, impulsiveness is the main factor behind suicide attempts. She said that expanding mental health services is like “cutting doorways into an empty building’’ because of how unpredictable suicidal attempts can be and that bringing awareness to mental health problems is not the only solution. 

Meanwhile, public health specialist Sara Goreman and psychiatrist Jack M Goreman made a case for antidepressants in their piece published recently in Psychology Today. The researchers were convinced by epidemiological data that antidepressants have successfully prevented many adults from committing suicide.

The answer is not dichotomous as the true reason leading to suicide attempts seems to evade many renowned psychiatrists. A paper published by PubMed Central in 2017 highlighted the need for more research on whether suicidal ideation is caused by taking antidepressants as one study in 2003 had found.

The same paper also said that people who are resistant to depression treatment have a history of substance abuse and have attempted suicide in the past are more prone to committing suicide. But now there needs to be a paradigm shift to better understand the role of antidepressants in treating suicidal behavior.