Patients at risk of suicide and overdose.

Suicide is a complex and confusing subject. Although social factors may be important a clear relationship has been established between suicide and some medical conditions, notably depression, schizophrenia and alcohol dependence. Primary care physicians are in the "front line" as far as the recognition of suicidal risk is concerned. There is good evidence that many individuals who commit suicide have had recent contact with medical services. Those who have attempted suicide are at a much greater risk of subsequently completing the act than the general population. Poisoning by solids or liquids is a common method of committing suicide. Prescribed medication is often used. Antidepressants vary considerably in their toxicity in overdosage. Newer compounds, including moclobemide appear to be safer than older ones. There is some evidence that suicide rates can be influenced by changing the availability of lethal substances and methods. It is suggested the prescription of toxic antidepressants should be restricted or avoided in patients in whom the risk of suicide is high.