Suicide in schizophrenia: The effect of clozapine

From 9 to 13% of patients with schizophrenia commit suicide. Risk factors include previous suicide attempts, recent onset, male gender, depression, and hopelessness. Recent evidence suggests that clozapine may decrease the rate of suicide or suicide attempts and that this may be related to antidepressant drug action. This effect has significance in terms of the risk-benefit assessment of clozapine and the cost-effectiveness of using this drug. The death rate due to clozapine-induced agranulocytosis is 1.5 in 10,000. This may be offset by a reduced rate of suicide.