People thought neuroleptics could cause suicide when they were first introduced but now they think they help with suicide

I've found something interesting in a paper published in 1990. Nowadays
neuroleptics are thought to improve the suicide rate, especially drugs
like clozapine, but back when neuroleptics were first introduced it was
thought they may increase the number of suicides because of they cause
depression.

What's changed? The medications have gotten more targeted in the bits of
the brain they work on.

My (little) experience of drugs like Olanzapine makes me think atypical
antipsychotics aren't much better however I've heard very good reports
about aripiprazole from 2 people who've taken it. Mental health
practice, by which I mean the experience a person has of medical care,
has also changed significantly. The 20th latter century saw empowerment,
advocacy, involvement, choice and all manner of changes that returned
power and humanity to individuals with severe mental illnesses. It may
also have seen more compassion and sensitivity from clinicians. It is my
guess that this progress towards humanisation would make people that
little bit happier and that little bit less likely to kill themselves.

A population study looking at the suicide rate and medication today will
show that antipsychotics can significantly reduce the suicide rate.
There was one published last year that got into the media and it showed
just how effective clozapine was - it was enough for the authors and the
press to call for clozapine to become a first line treatment. That
particular study was flawed because while it looked at medication it
couldn't control for the effect of accessing services. The people in the
study that didn't receive antipsychotic medication of any kind would
probably not be in contact with mental health services.

That means that people should maintain contact with mental health
services but many suicidal people clearly don't. I don't know why that
is. There must e some research somewhere on that. Identifying the
different reasons why people don't stay in contact with services may
provide useful information for clinical practice, the result of which
may be an increase in the number of people with severe mental illnesses
who maintain contact with services. It is my hope that that sort advance
in the of patient-service relationship in real terms could mean fewer
people commit suicide.

http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636
<http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636>

Schizophrenics kill themselves too: A review of risk factors for suicide.

"
Two common beliefs about suicide
among schizophrenic persons have
not been borne out by mortality
studies. With the introduction of
neuroleptics in the 1950's came the
fear that the combination of neuroleptics
and hospital liberalization policies
might result in an increase in
depression and suicide among schizophrenic
patients (Saugstad and
Cdegard 1979). However, early reports
(Beisser and Blanchette 1961;
Hussar 1962) of an increase in suicide
among schizophrenic patients
treated with neuroleptics have not
persisted over time. In fact, only one
study (Warnes 1968) has found a significant
difference between suicide
and control groups with regard to
neuroleptics, reporting that significantly
more control subjects were on
higher doses of phenothiazines.
Other studies (Cohen et al. 1964;
Roy 1982a, 1982b, 1986a, 1986b;
Hogan and Awad 1983; Wilkinson
and Bacon 1984) found no significant
difference in neuroleptic treatment
between suicide and control groups.
In reviewing the literature, Johns and
colleagues (1986) reported that they
found little support for the notion
that neuroleptics precipitated suicide
by the mechanism of depression induction.
"