Clozapine Diminishes Suicidal Behavior: A Retrospective Evaluation of Clinical Records
J Clin Psychiatry 2005;66(4):534-538
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: To test the antisuicidal effect of
clozapine, taking into consideration some potentially confounding
Method: A retrospective evaluation was conducted
of the clinical charts of 94 inpatients treated continuously with
clozapine for at least 6 weeks between 1962 and 1994. In a mirror
design, a period of continuous clozapine treatment (mean duration
of 15 months) was compared with a pre-clozapine period of equal
length, and in 17 patients also with a post-clozapine period,
with regard to suicidal behavior. The role of variables such as
staying in a protective hospital milieu and receiving treatment
with typical neuroleptics and antidepressants was considered.
Results: The rate of suicidal behavior was 28%
(26/94) in the pre-clozapine period, 3% (3/94) in the clozapine
period, and 18% (3/17) in the post-clozapine period, the
corresponding figures for serious suicidal behavior requiring
medical attention being 12% (11/94), 1% (1/94), and 12% (2/17),
respectively. The odds ratios were 11.6 (95% CI = 3.4 to 39.9) and
12.3 (95% CI = 1.6 to 97.5) for suicidal and serious suicidal
behavior, respectively, in favor of the clozapine period in
comparison with the pre-clozapine period. Staying in the hospital
was associated with reduction in suicidal behavior. The
antisuicidal effect of clozapine possibly disappears at doses
that are too low.
Conclusion: Clozapine diminishes the frequency
of suicidal behavior including serious suicidal acts, regardless
of comedication with antidepressants. In the protective hospital
milieu, this effect is less pronounced, and it disappears after