Effect of dopamine partial agonist antipsychotics on suicide risk in persons with schizophrenia and schizoaffective disorders: A systematic review and meta-analysis.
Jeff W Jin, Charlotte J Winkler, Heather B Blunt et al.
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In 30 seconds
This systematic review and meta-analysis examined whether dopamine partial agonist antipsychotics (DPAs) affect suicide outcomes in people with schizophrenia or schizoaffective disorders. Twenty articles were included; 13 excluded participants at higher suicide risk. In randomized controlled trials, DPAs did not significantly alter primary outcomes (suicide deaths and attempts) versus placebo (RR = 0.65, p = 0.38), or secondary outcomes (suicidal ideation; RR = 0.63, p = 0.15). Open-label extension studies showed increased incidence of both outcome groups, but substantial heterogeneity limits interpretation. The authors conclude that current trial evidence does not show a significant effect.
Key findings
- In randomized trials, primary suicide outcomes did not differ significantly from placebo (RR = 0.65, p = 0.38).
- Secondary outcomes, including suicidal ideation, were not significantly changed in randomized trials (RR = 0.63, p = 0.15).
- Open-label extensions showed increased incidence of primary (Ip = 0.004, p = 0.048) and secondary outcomes (Ip = 0.024, p = 0.0013), with marked heterogeneity.
Why it matters
Suicide prevention remains an important treatment challenge in schizophrenia. This synthesis finds no significant randomized-trial evidence that dopamine partial agonists reduce or increase suicide outcomes, so their potential role in suicide prevention remains uncertain. The open-label signal warrants cautious interpretation rather than being treated as evidence of a causal effect.
What to keep in mind
Thirteen included articles excluded participants at higher suicide risk, limiting applicability to that group. Open-label extension findings had marked study heterogeneity.