Gustavo C. Medeiros, Marjorie Mastellaro Baruzzi, Loren Beiram, Guilherme Pimenta Roncete, Leticia Lopes de Figueiredo, Laís de Deus Murta Nery, Mariana Filippini Cacciacarro, Marcus V. Zanetti, Rodolfo Furlan Damiano
Suicidality is a major global public health challenge increasingly recognized as a complex transdiagnostic construct. Traditional approaches often target specific disorders, whereas current neurobiological models—such as the “brake and accelerator” theory of neural circuitry and inflammatory dysregulation—offer new avenues for intervention. Pharmacological and neuromodulatory strategies constitute a critical component of care, with evidence supporting agents such as lithium (particularly in bipolar disorder) and clozapine (in schizophrenia spectrum disorders), alongside rapid-acting therapeutics such as (es)ketamine and somatic treatments such as electroconvulsive therapy. Crucially, clinical management must move beyond general efficacy to address precision treatments, distinguishing between acute crisis relief and long-term risk reduction. Integrating these biological tools into a comprehensive, personalized prevention strategy is critical in patient care, bridging the gap between neuroscientific insights and routine clinical decision making to optimize outcomes for at-risk populations.