Addressing Suicidality by Samantha Miernicki, PharmD
Every 12 minutes, approximately one death occurs due to suicide, according to the most recent data published in 2016 from the Centers of Disease Control and Prevention. In 2016, 9.8 million American adults seriously thought about suicide, 2.8 million created a plan to commit suicide, and 1.3 million attempted suicide. Suicide is the 10th leading cause of death in the United States, and the 15th cause of death internationally. Suicide is a growing health concern, yet there are currently no effective or approved treatments for suicide available.
Dr. David Sheehan, a world-renowned psychiatrist, discussed suicidality as part of Roth Capital’s “Our Untapped Large Market Opportunity Expert Call Series: Suicidality.” Dr. Sheehan provided insights into suicide and suicidality, as well as potential emerging treatments for suicidality. He addressed a common misconception that suicide is equivalent to depression. In actuality, suicide is not confined to depressive disorders, and is associated with almost every Axis 1 disorder, as classified by the Diagnostic and Statistical Manual of Mental Disorders. He further emphasized the importance of distinguishing between suicidal ideations and suicidality. Suicidality involves more than suicidal thoughts and ideations, and is characterized by impulsive, unprovoked attacks of an urgent need to kill oneself. Suicidality encompasses a wide range of core suicidality phenomena, and there are currently 12 phenotypes of suicidality disorders that have been identified based on preliminary evidence. Research into genetic biomarkers associated with suicide is also underway and may help to distinguish different forms and core phenomena of suicidality, as well as aid in the development of suicidality treatments.
Several drugs are currently being investigated for suicidality, one of which is ketamine, a noncompetitive NMDA receptor antagonist that blocks glutamate. Ketamine has been validated by many studies for use in both depression and suicidality, and has a previously established safety and efficacy profile for use as an anesthetic. In addition, alternate routes of administration, such as an intranasal spray, may provide a more rapid and convenient dosing form. If the well-known side effects of drug abuse and dissociation effects can be limited, ketamine has the potential to be a fast-acting, effective treatment for suicidality. Further research into ketamine’s underlying mechanism of action may elucidate fundamental information for designing and developing drugs specifically targeted to treating suicidality. With numerous drugs in the pipeline and ongoing research into genetic biomarkers, there is an exciting future ahead for the treatment of suicidality, and the potential to impact millions of patients.