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Krankenhauspsychiatrie 2005; 16: 27-33
DOI: 10.1055/s-2005-870990
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Depression und Suizid: Sind antidepressive Therapien bei der Akut- und Langzeittherapie uni- und bipolarer affektiver Erkrankungen suizidpräventiv?

Depression and Suicide: Antidepressive Therapies in the Acute and Chronic Treatment of Unipolar and Bipolar Affective Disorders - are they Preventive According to Suicide?T.  Bronisch1
  • 1Max-Planck-Institut für Psychiatrie, Klinik, München
Herrn Prof. Dr. med. Hans-Jürgen Möller zum 60. Geburtstag gewidmet.
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Publication History

Publication Date:
12 October 2005 (online)

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Zusammenfassung

Die pharmakologische Behandlung der Suizidalität bei unipolaren und bipolaren Störungen umfasst Antidepressiva, Neuroleptika, Lithium und Mood Stabilizer. Für eine antisuizidale Wirksamkeit bei diesen Störungen bietet Lithium derzeit die beste empirische Evidenz, für Antidepressiva wird eine starke bis schwächere oder gar fehlende Wirksamkeit postuliert. Indirekte Studien (Post-mortem, psychologische Autopsie, epidemiologische und Interventionsstudien) geben den besten Hinweis für eine starke Wirksamkeit von Antidepressiva. Für Neuroleptika und Mood Stabilizer ist die Datenlage zu schwach, um eine Aussage machen zu können. Insgesamt sind dringend prospektive, möglichst plazebo-kontrollierte Studien, an akut und chronisch suizidalen, unipolar und bipolar Depressiven notwendig.

Abstract

The antisuicidal pharmacological treatment comprises antidepressants, neuroleptics, lithium, and mood stabilizers. Lithium seems to have at the moment the best empirical results in treatment of suicidality, whereas a weak, moderate or strong efficacy is postulated for antidepressants. Indirect studies (post-mortem, psychological autopsy, epidemiological, and intervention studies) give indicators for a strong efficacy of antidepressants. Data are not sufficient for evaluating the antisuicidal properties of neuroleptics and mood stabilizers. In summary, there is an urgent need for, if possible prospective placebo controlled studies of acute or chronic unipolar and bipolar depressives.

Schlüsselwörter

Suizid - Suizidversuche - Depression - Pharmakotherapie

Key words

Suicide - suicide attempt - depression - pharmacotherapy

Literatur

  • 1 Mombour W, Kockott G. Diagnoseschlüssel und Glossar psychiatrischer Krankheiten. Berlin, Heidelberg, New York: Springer 1972
    Search in Google Scholar
  • 2 Dilling H, Mombour W, Schmidt M H. .Weltgesundheitsorganisation. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Bern, Göttingen, Toronto: Hans Huber 1991
    Search in Google Scholar
  • 3 American Psychiatric Association .Diagnostic and Statistical manual of Mental Disorders, ed. 3 - DSM-III. Washington D.C.: American Psychiatric Association 1980
    Search in Google Scholar
  • 4 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, ed. 4 (DSM-IV). Washington D.C.: American Psychiatric Association 1994
    Search in Google Scholar
  • 5 Angst J, Angst F, Gerber-Werder R, Gamma A. Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up.  Archives of Suicide Research. 2005;  9 279-300
    CrossrefSearch in Google Scholar
  • 6 Guze S B, Robins E. Suicide in primary affective disorders.  British Journal of Psychiatry. 1970;  117 437-438
    Search in Google Scholar
  • 7 Goodwin F K, Fireman B, Simon G E, Hunkeler E M, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex.  Journal of the American Medical Association. 2003;  290 1467-1473
    CrossrefSearch in Google Scholar
  • 8 Chen Y W, Dilsaver S C. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders.  Biological Psychiatry. 1996;  39 896-899
    CrossrefPubMedSearch in Google Scholar
  • 9 Tondo L, Isacsson G, Baldessarini R J. Suicidal behavior in bipolar disorder. Risk and prevention.  CNS Drugs. 2003;  17 491-511
    CrossrefSearch in Google Scholar
  • 10 International Consensus Group on bipolar I depression treatment guidelines . Journal of Clinical Psychiatry. 2004;  65 569-579
  • 11 Ösby U, Brabdt L, Correia N, Ekbom A, Sparén P. Excess mortality in bipolar and unipolar disorder in Sweden.  Archives of General Psychiatry. 2001;  58 844-850
    CrossrefSearch in Google Scholar
  • 12 Rihmer Z, Kiss K. Bipolar disorders and suicidal behaviour.  Bipolar Disorders. 2002;  4 (Suppl.) 21-25
    CrossrefSearch in Google Scholar
  • 13 Bronisch T. The relationship between suicidality and depression.  Archives of Suicide Research. 1996;  2 235-254
    Search in Google Scholar
  • 14 Lönnqvist J K. Psychiatric aspects of suicidal behavior: Depression. In: Hawton K, van Heeringen K (eds). The international handbook of suicide and attempted suicide. Chichester: Wiley 2000: 107-120
    Search in Google Scholar
  • 15 American Psychiatric Association .Practice guideline for major depressive disorder in adults. Washington, D.C.: American Psychiatric Press 1993
    Search in Google Scholar
  • 16 American Psychiatric Association .Practice guideline for the treatment of patients with bipolar disorder. Washington, D.C.: American Psychiatric Press 1994
    Search in Google Scholar
  • 17 Montgomery D B, Roberts A, Green M, Bullock T, Baldwin D, Montgomery S A. Lack of efficacy of fluoxetine in recurrent brief depression and suicidal attempts.  European Archives of Psychiatry and Clinical Neuroscience. 1994;  244 211-215
    CrossrefSearch in Google Scholar
  • 18 Montgomery S A, Dunner D L, Dunbar G C. Reduction of suicidal ideation with paroxetine in comparison with reference antidepressants and placebo.  European Neuropsychopharmacology. 1995;  5 5-13
    CrossrefSearch in Google Scholar
  • 19 Mujien M, Roy D, Silverstone T, Mehmet A, Christie M. A comparative clinical trial of fluoxetine, mianserin and placebo in depressed outpatients.  Acta Psychiatrica Scandinavica. 1988;  78 384-390
    Search in Google Scholar
  • 20 Rouillon F, Phillips R, Serrurier D, Ansart E, Gérard M J. Rechutes de dépression unipolaire et efficacité de la maprotiline.  Encéphale. 1989;  15 527-534
    Search in Google Scholar
  • 21 Wakelin J S. The role of sertonin in depression and suicide: Do serotonin reuptake inhibitors provide a key?.  Advances in Biological Psychiatry. 1988;  17 70-83
    Search in Google Scholar
  • 22 Dunbar G C, Mewett S. Evaluation of suicidal thoughts and acts with paroxetine. In: Smith Kline Beechan Pharmaceuticals (eds). Antidepressants: novel selective 5-HT uptake inhibitors. 5th World Congress of Biochemical Psychiatry, Florence/Italy, June 9 - 14, 1991. London: Franklin Scientific Projects 1991
    Search in Google Scholar
  • 23 Szanto K, Mulsant B H, Houck P, Dew M A, Reynolds III C F. Occurrence and course of suicidality during short-term treatment of late-life depression.  Archives of General Psychiatry. 2003;  60 610-617
    CrossrefSearch in Google Scholar
  • 24 Soloff P H, George A, Nathan R S, Schulz P M, Perel J M. Paradoxical effects of amitriptyline on borderline patients.  American Journal of Psychiatry. 1986;  143 1603-1605
    Search in Google Scholar
  • 25 Verkes R J, Mast R C van der , Hengeveld M W, Tuyl J P, Zwinderman A H, Kempen G MJ van. Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression.  American Journal of Psychiatry. 1998;  155 543-547
    Search in Google Scholar
  • 26 Jick H, Ulcickas M, Dean A. Comparison of frequencies of suicidal tendencies among patients receiving fluoxetine, lofepramine, mianserin, or trazodone.  Pharmacotherapy. 1992;  12 451-454
    Search in Google Scholar
  • 27 Jick H, Kaye J A, Jick S S. Antidepressant and the risk of suicidal behaviors.  JAMA. 2004;  292 338-343
    CrossrefSearch in Google Scholar
  • 28 Möller H J, Steinmeyer E M. Are serotonergic reuptake inhibitors more potent in reducing suicidality? An empirical study on paroxetine.  European Neuropsychopharmacology. 1994;  4 55-59
    CrossrefSearch in Google Scholar
  • 29 Mullin J M, Pandita-Gunawardena V R, Whitehead A M. A double-blind comparison of fluvoxamine and dothiepin in the treatment of major affective disorder.  British Journal of Clinical Practice. 1988;  42 51-55
    Search in Google Scholar
  • 30 Montgomery S A, McAuley R, Rani S J, Roy D, Montgomery D. A double-blind comparison of zimelidine and amitriptyline in endogenous depression.  Acta Psychiatrica Scandinavica. 1981;  63 (Suppl 290) 314-327
    Search in Google Scholar
  • 31 Vogel H, Bente J, Feder H, Helmchen H, Müller-Oerlinghausen B, Bohacek N, Mihovilovic M, Brändli A, Fleischhauer J, Walcher W. Mianserin versus amitriptyline. A double blind trial evaluated by the AMP system.  International Pharmacopsychiatry. 1976;  11 25-31
    Search in Google Scholar
  • 32 Fava M, Rosenbaum J F. Suicidality and fluoxetine: Is there a relationship?.  Journal of Clinical Psychiatry. 1991;  52 108-111
    Search in Google Scholar
  • 33 Teicher M H, Glod C, Cole J O. Emergence of intense suicidal preoccupation during fluoxetine treatment.  American Journal of Psychiatry. 1990;  147 207-210
    CrossrefPubMedSearch in Google Scholar
  • 34 King R A, Riddle M A, Chappell P B, Hardin M T, Anderson G M, Lombroso P. et al . Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment.  Journal of the American Academy of Child and Adolescence Psychiatry. 1991;  30 179-186
    Search in Google Scholar
  • 35 Rothschild A J, Locke C A. Reexposure to fluoxetine after serious suicide attempts by three patients: the role of akathisia.  Journal of Clinical Psychiatry. 1991;  52 491-493
    Search in Google Scholar
  • 36 Creaney W, Murray I, Healy D. Antidepressant induced suicidal ideation.  Human Psychopharmacology. 1991;  6 329-323
    Search in Google Scholar
  • 37 Damluji N F, Ferguson J M. Paradoxical worsening of depressive symptomatology caused by antidepressants.  Journal of Clinical Psychopharmacology. 1988;  8 347-349
    Search in Google Scholar
  • 38 Dasgupta K. Additional cases of suicidal ideation associated with fluoxetine.  American Journal of Psychiatry. 1990;  147 1570
    Search in Google Scholar
  • 39 Hoover C E. Additional cases of suicidal ideation associated with fluoxetine.  American Journal of Psychiatry. 1990;  147 1570-1571
    Search in Google Scholar
  • 40 Masand P, Gupta S, Dewan M. Suicidal ideation related to fluoxetine.  New England Journal of Medicine. 1991;  324 420
    Search in Google Scholar
  • 41 Vorstmann J, Lahuis B, Buitelaar J K. SSRIs associated with behavioral activation and suicidal ideation (letter).  Journal of the American Academy of Child and Adolescent Psychiatry. 2001;  40 1364-1365
    Search in Google Scholar
  • 42 Kapur S, Mieczkowski T, Mann J J. Antidepressant medications and the relative risk of suicide attempt and suicide.  JAMA. 1992;  268 3441-3445
    CrossrefSearch in Google Scholar
  • 43 Black D W, Warrack G, Winokur G. The Iowa Record Linkage Study. I. Suicides and accidental deaths among psychiatric patients.  Archives of General Psychiatry. 1989;  42 71-75
    Search in Google Scholar
  • 44 Angst F, Stassen H H, Clayton P J, Angst J. Mortality of patients with mood disorders: follow-up over 34 - 38 years.  Journal of Affective Disorders. 2002;  68 167-181
    CrossrefSearch in Google Scholar
  • 45 Leon A C, Keller M B, Warshaw M G, Müller T I, Solomon D A, Coryell W, Endicott J. Prospective study of fluoxetine treatment and suicidal behavior in affectively ill subjects.  American Journal of Psychiatry. 1999;  156 195-201
    Search in Google Scholar
  • 46 Yerevanian B I, Koek R J, Feusner J D, Hwang S, Mintz J. Antidepressants and suicidal behavior in unipolar depression.  Acta Psychiatrica Scandinavica. 2004;  110 452-458
    CrossrefSearch in Google Scholar
  • 47 Donovan S, Clayton A, Beeharry M, Johns S, Kirk C, Waters K, Gardner D, Faulding J, Madeley R. Deliberate self-harm and antidepressant drugs. Investigation of an possible link.  British Journal of Psychiatry. 2000;  177 551-556
    CrossrefSearch in Google Scholar
  • 48 Donovan S, Kelleher J, Lambourn J, Foster T. The occurrence of suicide following the prescription of antidepressant drugs.  Archives of Suicide Research. 1999;  5 181-192
    CrossrefSearch in Google Scholar
  • 49 Zuninelli R, Meister W. The treatment of depression with paroxetine in psychiatric practice in Germany: The possibilities and current limitations of drug monitoring.  Pharmacopsychiaty (supplement). 1997;  30 9-20
    Search in Google Scholar
  • 50 Gibbons R D, Hur K, Bhaumoik D K, Mann J J. The relationship between antidepressant medication use and rate of suicide.  Archives of General Psychiatry. 2005;  62 165-172
    Search in Google Scholar
  • 51 Khan A, Warner H A, Brown W. Sympton reduction and suicide risk in patients treated with placebo in antridepressant clinical trails.  Archives of General Psychiatry. 2000;  57 311-317
    CrossrefSearch in Google Scholar
  • 52 Khan A, Kahn S R, Leventhal R M, Brown W A. Symptom reduction and suicide risk among patients treated with placebo in antipsychotic drug trials: an analysis of the food and drug administration database.  American Journal of Psychiatry. 2001;  158 1449-1454
    CrossrefSearch in Google Scholar
  • 53 Khan A, Kahn S R, Leventhal R M, Brown W A. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: a replication analysis of the food and drug administration data base.  International Journal of Neuropsychopharmqacology. 2001;  4 113-118
    Search in Google Scholar
  • 54 Khan A, Khan S, Kolts R, Brown W A. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of fda reports.  American Journal of Psychiatry. 2003;  160 790-792
    CrossrefSearch in Google Scholar
  • 55 Storosum J G, Zwieten B J van, Brink W van den, Gersons B PR, Broekmans A W. Suicide risk in placebo controlled studies of major depression.  American Journal Psychiatry. 2001;  158 1271-1275
    CrossrefSearch in Google Scholar
  • 56 Beasley Jr C M, Dornseif B E, Bosomworth J C, Sayler M E, Rampey Jr A H, Heiligenstein J H, Thompson V L, Murphy D J, Masica D N. Fluoxetin and suicide: a meta-analysis of controlled trials of treatment for depression.  British Medical Journal. 1991;  303 685-692
    Search in Google Scholar
  • 57 Rothschild A J, Samson J A, Bessette M P. et al . Efficacy of the combination of fluoxetine and perphenazine in the treatment of psychotic depression.  Journal of Clinical Psychiatry. 1993;  54 338-342
    Search in Google Scholar
  • 58 Spiker D G, Weiss J C, Dealy R S. et al . The pharmacological treatment of delusional depression.  American Journal of Psychiatry. 1985;  142 430-436
    Search in Google Scholar
  • 59 Shelton R C. The combination of olanzapine and fluoxetine in mood disorders.  Expert Opinion Pharmacotherapy. 2003;  4 1175-1183
    Search in Google Scholar
  • 60 Meltzer H Y, Alphs L, Green A L, Altamura A C, Anand R, Bertoldi A, Bourgeois M, Chouinard G, Islam Z, Kane J, Krishnan R, Lindenmayer J-P, Potkin S. Clozapine treatment for suicidality in schizophrenia. International Suicide Prevention Trial (InterSePT).  Archives of General Psychiatry. 2003;  60 82-91
    Search in Google Scholar
  • 61 Montgomery S A, Montgomery D B, Rani S J, Roy D, Shaw P J. Maintenance therapy in repeat suicidal behavior: a placebo controlled trial. Ottawa: Proc. Xth Int. Congr. for Suicide Prevention 1979: 227-229
    Search in Google Scholar
  • 62 Montgomery S A, Roy D, Montgomery D B. The prevention of recurrent suicidal acts.  British Journal of Clinical Pharmacology. 1983;  15 183-188
    Search in Google Scholar
  • 63 Müller-Oerlinghausen B, Ahrens B, Grof E, Grof P, Lenz G, Schou M, Simhandl C, Thau K, Volk J, Wolf R, Wolf T. The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizo-affective illness.  Acta Psychiatrica Scandinavica. 1992;  86 218-222
    Search in Google Scholar
  • 64 Ahrens B, Müller-Oerlinghausen B, Schou M, Wolf T, Alda M, Grof E, Grof P, Lenz G, Simhandl C, Thau K, Wolf R, Möller H J. Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium-prophylaxis.  Journal of Affective Disorders. 1995;  33 67-75
    CrossrefSearch in Google Scholar
  • 65 Müller-Oerlinghausen B, Felber W, Berghöfer A, Lauterbach E, Ahrens B. The impact of lithium long-term medication on suicidal behavior and mortality of bipolar patients.  Archives of Suicide Research. 2005;  9 307-319
    CrossrefSearch in Google Scholar
  • 66 Tondo L, Baldessarini R J, Floris G. et al .Lithium maintenance treatment reduces risk of suicidal behavior in bipolar disorder patients. In: Gallicchio VS, Birch NJ (eds). Lithium: Biochemical and clinical advances. Cheshire, Conn: Weidner Publishing Group 1996: 161-171
    Search in Google Scholar
  • 67 Tondo L, Jamison K R, Baldessarini R J. Effect of lithium maintenance on suicidal behavior in major mood disorders.  In: Stoff DM, Mann JJ (eds). The neurobiology of suicide: From the bench to the clinic  Annals of the New York Academy of Science. 1997;  836 339-351
    Search in Google Scholar
  • 68 Ahrens B, Müller-Oerlinghausen B. Does lithium exert an independent antisuicidal effect?.  Pharmacopsychiatry. 2001;  34 132-136
    Thieme ConnectSearch in Google Scholar
  • 69 Lauterbach E, Ahrens B, Felber W, Müller-Oerlinghausen B, Kilb B, Bischof G, Heuser I, Werner P, Hawellek B, Maier W, Lewitzka U, Pogarell O, Hegerl U, Bronisch T, Richter K, Niklewski G, Broocks A, Hohagen F. Suicide Prevention by Lithium - a multicenter prospective study (SUPLI).  Archives of Suicide Research. 2005;  9 27-34
    Search in Google Scholar
  • 70 Thies-Flechtner K, Müller-Oerlinghausen B, Seibert W, Walther A, Greil W. Effect of prophylactic treatment on suicide risk in patients with major affective disorders. Data from a randomized prospective trial.  Pharmacopsychiatry. 1996;  29 103-107
    Search in Google Scholar
  • 71 Greil W, Ludwig-Mayerhofer W, Erazo N, Schöchlin C, Schmidt S, Engel R R, Czernik A, Giedke H, Müller-Oerlinghausen B, Osterheider M, Rudolf G AE, Sauer H, Tegeler J, Wetterling T. Lithium versus carbamazepine in the maintenance treatment of bipolar disorders - a rondomised study.  Journal of Affective Disorders. 1997;  43 151-161
    CrossrefSearch in Google Scholar
  • 72 Goodwin F K, Jamison K R. Manic-depressive illness.  New York, NY: Oxford University Press 1990
    Search in Google Scholar
  • 73 Yerevanian B I, Koel R J, Mintz J. Lithium, anticonvulsants, and suicidal behavior in bipolar disorder.  Journal of Affective Disorders. 2003;  73 223-228
    CrossrefSearch in Google Scholar
  • 74 Born Ch, Dittmann S, Post R M, Grunze H. Newer prophylactic agents for bipolar disorder and their influence on suicidality.  Archives of Suicide Research. 2005;  9 301-306
    CrossrefSearch in Google Scholar
  • 75 Andersen U A, Andersen M, Rosholm J U, Gram L F. Psychopharmacological treatment and psychiatric morbidity in 390 cases of suicide with special focus on affective disorders.  Acta psychiatrica Scandinavica. 2001;  104 458-465
    CrossrefSearch in Google Scholar
  • 76 Henriksson S, Boethius G, Isacsson G. Suicides are selfdom prescribed antidepressants: findings from a prospective prescriptionj database in Jämtland county, Sweden 1985 - 1995.  Acta Psychiatrica Scaninavica. 2001;  103 301-306
    Search in Google Scholar
  • 77 Isacsson G, Holmgren P, Wasserman D, Bergman U. Use. Psychotropics and suicide prevention. Implications from toxicological screening of 5281 suicides in Sweden 1992 - 1994.  British Journal of Psychiatry. 1994;  151 1020-1024
    Search in Google Scholar
  • 78 Jick S, Dean A, Jick H. Antidepressants and suicide.  British Medical Journal. 1995;  310 215-218
    Search in Google Scholar
  • 79 Isacsson G, Boethius G, Bergmann U. Low level of antidepressive prescription for people who latercommit suicide: 15 years of experience from population based drug database in Sweden.  Acta Psychiatrica Scandinavica. 1992;  85 444-448
    Search in Google Scholar
  • 80 Isacsson G, Bergman U, Rich C L. Antidepressants, depression and suicide: an analysis of the San Diego Study.  Journal of Affective Disorder. 1994;  32 277-286
    Search in Google Scholar
  • 81 Isacsson G, Holmgren P, Druid H, Bergmann U. Theutilization of antidepressants - a key issue in the prevention of suicide, an analysis of 5281 suicides in Sweden 1992 - 1994.  Acta Psychiatrica Scandinavica. 1997;  96 94-100
    CrossrefSearch in Google Scholar
  • 82 Isometsae E T, Henriksson M M, Aro H M, Heikkinen M E, Kuoppasalmi K I, Lönnqvist J K. Suicide in major depression.  American Journal of Psychiatry. 1994;  151 530-536
    Search in Google Scholar
  • 83 Barbui C, Campomori A, Dávanzo B. et al . Antidepressant drug use in Italy since the introduction of SSRIs: national trends, regional differences and impact on suicide rates.  Social Psychiatry Psychiatric Epidemiology. 1999;  34 152-156
    CrossrefSearch in Google Scholar
  • 84 Grunebaum M F, Ellis S P, Shuhua L I, Oquendo M A, Mann J J. Antidepressants and suicide risk.  Journal of Clinical Psychiatry. 2004;  65 1456-1462
    Search in Google Scholar
  • 85 Hall W D, Mant A, Mitchell A. et al . Association between antidepressant prescribing and suicide in Australia, 1991 - 2000; trendanalysis.  BMJ. 2003;  326 1008-1011
    Search in Google Scholar
  • 86 Leon A C, Marzuk P M, Tardiff K, Teres J J. Paroxetine, other antidepressants, and youth suicide in New York City: 1993 through 1998.  Journal of Clinical Psychiatry. 2004;  65 915-918
    Search in Google Scholar
  • 87 Ohberg A, Vuori E, Klaukka T. et al . Antidepressants and suicide mortality.  Journal of Affective Disorders. 1994;  50 225-233
    Search in Google Scholar
  • 88 Rihmer Z, Appelby L, Rihmer A, Belso N. Decreasing suicide in Hungary.  British Journal of Psychiatry. 2000;  177 84
    CrossrefSearch in Google Scholar
  • 89 Isacsson G. Suicide prevention - a medical breakthrough?.  Acta Psychiatrica Scandinavica. 2000;  102 113-117
    CrossrefSearch in Google Scholar
  • 90 Rutz W, Knorring L, Walinder J von. Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression.  Acta Psychiatrica Scandinavica. 1992;  85 83-88
    CrossrefSearch in Google Scholar
  • 91 Rutz W, Knorring L van, Pihlgren H, Rihmer Z, Walinder J. Prevention of male suicides: lessons from Gotland study.  Lancet. 1995;  345 524
    Search in Google Scholar
  • 92 Möller H J. Antidepressants - do they decrease or increase suicidality?.  Pharmacopsychiatry. 1992;  25 249-253
    Search in Google Scholar
  • 93 Möller H J. Suicide, suicidality and suicide prevention in affective disorders.  Acta Psychiatrica Scandinavica. 2003;  108 (suppl. 418) 73-80
    CrossrefSearch in Google Scholar
  • 94 Bronisch T. Depression and suicidal behavior. Letter to the editor.  Crisis. 2003;  24 179-180
    CrossrefSearch in Google Scholar

Prof. Dr. med. Thomas Bronisch

Max-Planck-Institut für Psychiatrie · Klinik

Kraepelinstr. 10

80804 München

Phone: 089-30622-239

Fax: 089-30622-223

Email: bronisch@mipsykl.mpg.de