In Review The Neurobiology of Suicide and Suicidality

Suicide and attempted suicide rarely occur outside a con-text of a psychiatric disorder. Despite advances in treating and preventing these disorders, recent epidemiologic research indicates that suicide and attempted suicide still constitute a major public health problem. Reasons for the apparent failure of improved treatments to reduce suicide have been identified and include simplistic explanatory models of suicidal behav-iour that portray suicide as simply a logical response to ex-treme stress (1). It is also commonly suggested that adequate treatment of a psychiatric disorder is sufficient to prevent sui-cide. This approach, however, does not take into account the heterogeneous symptomatology of psychiatric disorders (for example, sleep, appetite, mood, cognition) and outcome, in-cluding suicide. Moreover, such a simplistic approach implies no attention to the fact that a completed suicide is commonly preceded by a suicidal process—a process that may becom