The rate of suicide in the United States has increased dramatically in recent years-by approximately 30% in the first 16 years of this century. As part of a systematic review undertaken to update clinical practice guidelines on the evaluation and management of suicide risk, researchers focused on the benefits and harms of pharmacological and nonpharmacological treatments for people at risk for suicide.

They reviewed previously published systematic reviews and randomized controlled trials that focused on adults at risk for suicide. Moderate-strength evidence showed that cognitive behavioral therapy reduced suicide attempts, suicidal ideation, and hopelessness compared with treatment as usual (measures such as risk assessment and supportive listening). Low-strength evidence suggested that cognitive behavioral therapy didn't prevent or reduce suicides. Low-strength evidence showed that dialectical behavior therapy-which combines elements of cognitive behavioral therapy, skills training, and mindfulness techniques-is more effective than client-oriented therapy and wait-list control (in which participants are placed on a wait list and receive treatment after the intervention group) in reducing suicidal ideation.

Studies of pharmacological interventions showed that short-term intravenous ketamine reduced suicidal ideation compared with placebo or midazolam. In addition, lithium reduced rates of suicide in patients with unipolar or bipolar mood disorders compared with placebo. There were no differences, however, between lithium and various other active pharmacological treatments.

The authors point out that relying on previously published systematic reviews, as their study did, can result in potential bias. Considering the need for interventions to reduce suicide risk, they conclude that the lack of evidence supporting current nonpharmacological and pharmacological interventions, in addition to the lack of information regarding potential harms, is significant.