Toxicology of suicide: touchstone for suicide prevention?
BACKGROUND
Systematic studies of consecutive suicides show that risk for suicide concentrates heavily in people with psychiatric illness, particularly depressive disorders and substance abuse. It is generally assumed that suicide is preventable although there is currently no conclusive evidence for efficacy of any preventive action, including use of psychotropic prescription medications. The low base-rate of suicide and ethical concerns of studying suicidal people in controlled trials of medications or psychotherapy are the two most important obstacles for progress in suicide research. No prevention suicide program currently includes routine toxicological monitoring of suicide or other violent death. The use of toxicological monitoring in suicide was examined in this study.


METHODS
Review of the literature on toxicological studies of suicide, in particular of a study done in consecutive suicides in Mobile County, Alabama, between 1990-1998.


RESULTS
Toxicological studies in suicides support that there is undertreatment of depressive disorders in people who are at risk for suicide and that substance abuse is an important risk factor. Higher detection rates of antidepressants in recent suicide samples may indicate higher treatment rates of depression.


CONCLUSIONS
Surveillance of psychoactive substances among suicides may be a novel and practical way to assess efficacy of selected medical interventions aimed at reducing the number of suicides. Use of toxicological monitoring in suicide should be explored in future studies.
Dhossche
Dirk M
DM
Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, USA. dr6340451@pol.net
D000367:Age Factors; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000633:toxicity; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011619:Psychotropic Drugs / Q000633:toxicity; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data; D014116:Toxicology / Q000379:methods*; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs