Managing the risk of suicide in people with treatment-resistant depression

Managing suicide risk is a frequent challenge when caring for individuals with treatment-resistant depression (TRD). Suicide is a problem that has perplexed scholars, health care workers, and the general public for all of recorded history. Suicide violates our most basic drive for self-preservation, and yet it occurs in staggering numbers. Although the study of suicide has advanced our knowledge considerably in the past 30 years, suicide remains a poorly understood phenomenon. In this chapter, we summarize current knowledge of the phenomenology of and risk for suicide, and pay particular attention to developments in the ability to predict suicidal behavior. Next we discuss likely reasons why suicide is associated with TRD. We then outline treatment approaches that may benefit patients with TRD experiencing suicidal thoughts and behaviors. Finally, we highlight topics for further study that will advance our ability to understand and prevent suicide in TRD.