Bipolar pharmacotherapy and suicidal behavior. Part 3: Impact of antipsychotics

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles 10111 Plummer Street, North Hills, CA 91343, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 11/2007; 103(1-3):23-8. DOI: 10.1016/j.jad.2007.05.018
Source: PubMed


Antipsychotics, particularly second generation agents, are widely used in bipolar disorder, but their effect on suicidal behavior in this population has not been systematically studied.
Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month-by-month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Comparison of rates of suicidal events during mood stabilizer monotherapy, antipsychotic monotherapy, and combination of mood stabilizer and antipsychotic.
Non-lethal suicide event rates were 9.4 times greater (chi2=28.29, p<.0001) during antipsychotic monotherapy and 3.5 times greater during mood stabilizer+antipsychotic (chi2=15.13, p=0.0001) than during mood stabilizer monotherapy.
Antipsychotics may have been prescribed because patients were at greater risk of suicidal behavior. First and second generation antipsychotics were not distinguished.
Treatment of bipolar patients with antipsychotics is associated with an increase in non-lethal suicidal behavior. Thus, use of antipsychotics for bipolar patients requires careful monitoring for suicidal behavior. Further studies are urgently needed to better characterize this relationship.

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    • "Yerevenian et al. found additional prescribing of antidepressants (Yerevanian et al., 2007b) or antipsychotics (Yerevanian et al., 2007a) in addition to mood stabilisers was associated with increases in suicide. Furthermore, those taking antipsychotic monotherapy or antidepressant monotherapy were at highest risk of suicide. "
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