Neurological diseases expose individuals to a higher risk of suicidal ideation and suicidal
behavior, including completed suicides and suicide attempts. They also represent a paradigmatic arena
to study the etiopathogenic mechanisms underlying suicidality because they are emblematic of the heterogeneity
and complexity of mutual interrelationships characterizing this issue. On the one hand, neurological
diseases imply strictly biological impairments that are postulated to be the basis of vulnerability
to suicide or result in the need for treatments for which a suicidal risk has been hypothesized. On
the other hand, they question some subjective experiences of neurological patients, up to near existential
positions. Often, in fact, they are accompanied by severe hopelessness. The latter may originate in,
particularly for the most severe neurological diseases, the absence of curative treatments, unpredictable
disease progression that leads to acute relapses or chronicity, a decrease in autonomy or selfidentity,
progressive social isolation, a sense of becoming useless, and perception of feeling stigmatized.
This may ultimately cause a slip into experiencing an absurd condition. At the confluence of
neurobiology and hopelessness, frequent psychiatric comorbidities may play a primary role. To conclude,
neurological patients require special attention from clinicians in form of openly verbalizing and
exploring the suicidal thematic, inquiring about protective and risk factors, and promptly initiating
both a psychopharmacological treatment and, where possible, psychological support.