Pharmacotherapy for the Secondary Prevention of Suicide: Leads from the Social Pain Hypothesis

Suicidal behavior is a growing public health problem. Existing treatments have limited effectiveness for people who have already attempted suicide, so new approaches are needed. Research on the neurobiology of social pain—the distress from social rejection or loss—identifies it as a key risk factor and suggests several promising drug targets. This paper reviews evidence on those targets and examines how recently approved treatments like ketamine and psilocybin may reduce suicidal ideation and behavior in the short term, especially when social pain is a contributing factor. These pharmacological strategies may work regardless of whether a person has a specific psychiatric diagnosis.

Study at a glance

Abstract

Suicidal behaviour is a public health problem whose magnitude is both substantial and increasing. Since many individuals seek medical treatment following a suicide attempt, strategies aimed at reducing further attempts in this population are a valid and feasible secondary prevention approach. An evaluation of the available evidence suggests that existing treatment approaches have limited efficacy in this setting, highlighting the need for innovative approaches to suicide prevention. Existing research on the neurobiology of social pain has highlighted the importance of this phenomenon as a risk factor for suicide, and has also yielded several attractive targets for pharmacological preventive strategies. In this paper, the available evidence related to these targets is synthesized and critically evaluated. The way in which social pain is related to the “anti-suicidal” properties of recently approved treatments, such as ketamine and psilocybin, is also examined. Such strategies may be effective for the short-term reduction of suicidal ideation and behaviour in individuals who have made a suicide attempt suicide prevention, particularly in cases where social pain is identified as a contributory factor. These pharmacological approaches may be effective regardless of the presence or absence of a specific psychiatric diagnosis.