LAUSR

risk for suicide will help to refine short-term treatment strategies for these patients. Some potential treatments for suicidal patients deserve to be investigated in depth: first, the combination of lithium or antipsychotics with antidepressants; second, the nearly immediate and dramatic anti-suicidal effect of low doses of ketamine. This latter effect is particularly intriguing and might be explained by an impact on glutamatergic neurotransmission, particularly in the anterior cingulate cortex. There is also mounting evidence on the role of social, psychological and physical pain in suicidal behaviour. The l-opioid receptor system is involved not only in physical pain but also in the modulation of social pain, and represents a relevant target for suicide prevention. A four-week study in patients with elevated suicidal ideation showed that an ultra-low dose of sublingual buprenorphine was more effective than placebo in the reduction of that ideation. A call for caution is finally needed regarding the current risk of psychiatric patients to undergo physician-assisted suicide. Legalized physician-assisted suicide should not be a manifestation of therapeutic nihilism. It is ethically mandatory that evidence-based treatments and available anti-suicidal strategies be implemented whenever a psychiatric condition is present.