Talk therapy when added to medications shows efficacy for reducing suicide risk

Talk therapy when added to medications shows efficacy for reducing suicide risk.

Both cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) reduce suicide risk compared with usual treatment. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Findings from a systematic review are published in Annals of Internal Medicine and were used to inform clinical guidelines from the U.S. Department of Veterans Affairs and U.S. Department of Defense (VA/DoD).

Cognitive behavioural therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviours. CBT is commonly used to treat a wide range of disorders, including phobias, addictions, depression, and anxiety. Dialectical behavioural therapy (DBT) is a type of cognitive-behavioural therapy that includes skills training, and mindfulness techniques. A unique aspect of DBT is its focus on acceptance of a patient's experience as a way for therapists to reassure them -- and balance the work needed to change negative behaviours.

Suicide rates in the U.S. have increased by 30 per cent from 2000 to 2016 and suicide ideation, planning, and attempts have grown the most among persons aged 18 to 25 years. Suicide rates are especially high among veterans. As such, finding effective treatments and management strategies is imperative.

Researchers from the ECRI Institute reviewed and synthesized evidence from 8 systematic reviews and 15 randomized controlled trials of nonpharmacologic and pharmacologic interventions intended to prevent suicide in at-risk persons. Nonpharmacologic treatments included psychological interventions, such as CBT, or talk therapy, and DBT, which combines elements of CBT, skills training, and mindfulness techniques with the aim of helping persons with borderline personality disorder develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance. Pharmacologic treatments studied included ketamine and lithium. The researchers found moderate-strength evidence supporting the use of face-to-face or Internet-delivered CBT in reducing suicide attempts, suicidal ideation, and hopelessness compared with usual care. Low-strength evidence suggests that DBT could help reduce suicidal ideation. With regard to pharmaceutical treatments, the researchers found moderate-strength evidence supporting the use of short-term intravenous ketamine for reducing suicidal ideation and for the use of lithium for reducing suicide.

For more details click on the link: http://annals.org/aim/article/doi/10.7326/M19-2347