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Suicidal Behavior in Mood Disorders: Response to Pharmacological Treatment

  • Mood Disorders (MA Oquendo and MF Grunebaum, Section Editors)
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Abstract

Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with substantial evidence of preventive effects on suicidal behavior is long-term treatment with lithium. It is unclear whether this effect is specifically antisuicidal or reflects beneficial effects of lithium on depression, mood instability, and perhaps aggression and impulsivity. Antisuicidal effects of anticonvulsant mood stabilizers (carbamazepine, lamotrigine, valproate) appear to be less than with lithium. Further evaluation is needed for potential antisuicidal effects of atypical antipsychotics with growing evidence of efficacy in depression, particularly acute bipolar depression, while generally lacking risk of inducing agitation, mania, or mood instability. Short-term and long-term value and safety of antidepressants are relatively secure for unipolar depression but uncertain and poorly tested for bipolar depression; their effects on suicidal risk in unipolar depression may be age-dependent. Sedative anxiolytics are virtually unstudied as regards suicidal risks. Adequate management of suicidal risks in mood disorder patients requires comprehensive, clinically skillful monitoring and timely interventions.

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Authors and Affiliations

  1. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Leonardo Tondo & Ross J. Baldessarini

  2. International Consortium for Bipolar Disorder Research, McLean Hospital, 115 Mill Street, Belmont, MA, 02478-9106, USA

    Leonardo Tondo & Ross J. Baldessarini

  3. Lucio Bini Mood Disorder Centers, Cagliari and, Rome, Italy

    Leonardo Tondo

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  1. Leonardo Tondo
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  2. Ross J. Baldessarini
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Correspondence to Leonardo Tondo.

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Conflict of Interest

Leonardo Tondo and Ross J. Baldessarini declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Highlights

We review the following topics:

• The epidemiology of suicide in mood disorders.

• Special challenges for the design of studies aimed at testing for antisuicidal effects.

• Findings for and against long-term antisuicidal effects of antidepressants, anxiolytics, antipsychotics, anticonvulsants, and lithium.

• The place of psychotropic drugs in comprehensive clinical management of potentially suicidal patients.

• References of special interest are annotated.

This article is part of the Topical Collection on Mood Disorders

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Tondo, L., Baldessarini, R.J. Suicidal Behavior in Mood Disorders: Response to Pharmacological Treatment. Curr Psychiatry Rep 18, 88 (2016). https://doi.org/10.1007/s11920-016-0715-0

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  • DOI: https://doi.org/10.1007/s11920-016-0715-0

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