Which medication is indicated for suicidal behavior treatment?

• A. Risperidone
• B. Clozapine
• C. Paliperidone
• D. Quetiapine

Answer: (B)

Clozapine has a unique anti-suicidal effect in schizophrenia. It is the only antipsychotic with robust evidence showing a reduction in suicide attempts and deaths in patients with treatment-resistant schizophrenia, which is why it’s indicated when suicidal behavior or a high suicide risk is a major concern. This benefit has been demonstrated in clinical trials such as the InterSePT study, which found fewer suicidality outcomes with clozapine than with other antipsychotics.

However, this choice comes with important safety considerations: clozapine requires regular blood monitoring due to the risk of agranulocytosis and other serious adverse effects, along with potential weight gain, metabolic changes, seizures, and myocarditis. The other antipsychotics do not have the same proven anti-suicidal effect, so while they may help with psychotic symptoms, they lack the specific indication for suicidality reduction.