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Suicidal Behaviour in Bipolar Disorder

Risk and Prevention

  • Therapy in Practice
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Abstract

Bipolar (manic-depressive) disorder is a common and severe illness. It is also potentially fatal as a result of accidents and increased mortality associated with comorbid substance use and medical illnesses, but its highest lethality results from suicide. Suicide rates, averaging 0.4% per year in men and women diagnosed with bipolar disorder, are >20-fold higher than in the general population. Suicidal acts often occur early in the illness course and in association with severe depressive and dysphoric-agitated mixed phases of illness, especially following repeated, severe depressions.

Systematic consideration of risk and protective factors enhances assessment of potentially suicidal patients. Short-term interventions employed empirically to manage acute suicidality include close clinical supervision, rapid hospitalisation and use of electroconvulsive treatment. Several plausible therapeutic interventions have limited evidence of long-term effectiveness against mortality risks associated with any psychiatric disorder, including antidepressant, antimanic, antipsychotic and electroconvulsive, as well as psychosocial, treatments. However, in bipolar disorder and other major affective disorders, lithium maintenance treatment is a notable exception, with strong and consistent evidence that it reduces suicidal risk.

The growing range of drugs being introduced to treat acute and long-term phases of bipolar disorder, including antiepileptic drugs, atypical antipsychotics and relatively safe, modern antidepressants, require research assessment for their ability to limit premature mortality from suicide and other causes. For now, however, more can be done to improve treatment in major affective illnesses by application of current knowledge in a systematic fashion, with close and sustained clinical follow-up of patients at risk, hopefully with a resulting reduction of mortality rates.

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Acknowledgements

Supported, in part, by a Stanley Medical Research Institute award, a NARSAD Investigator award (Dr Tondo), an award from the Bruce J. Anderson Foundation and the McLean Private Donors Neuropsychopharmacology Research Fund (to Dr Baldessarini). Mr Matthew Albert provided valuable bibliographical assistance.

Dr Baldessarini has professional relationships (consulting agreements or research support) with the following corporations: Auritec Labs, Biostream Labs, Eli Lilly Labs (Indianapolis), GlaxoSmithKline Corp, IFI SpA, Janssen Pharmaceuticals, Protarga Corp and Solvay Corp. Dr Tondo has professional relationships (consulting agreement) with IFI SpA, Rome.

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  1. Department of Psychology, University of Cagliari, Centro Lucio Bini-Stanley Medical Research Institute Research Center, Cagliari, Sardinia, Italy

    Leonardo Tondo

  2. Bipolar & Psychotic Disorders Program, Department of Psychiatry, Harvard Medical School and the International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, Massachusetts, USA

    Leonardo Tondo & Ross J. Baldessarini

  3. Division of Psychiatry, Neurotec Institution, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden

    Göran Isacsson

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  1. Leonardo Tondo
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Correspondence to Leonardo Tondo.

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Tondo, L., Isacsson, G. & Baldessarini, R.J. Suicidal Behaviour in Bipolar Disorder. CNS Drugs 17, 491–511 (2003). https://doi.org/10.2165/00023210-200317070-00003

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