Bipolar pharmacotherapy and suicidal behavior Part 3: impact of antipsychotics.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Antipsychotics may have been prescribed because patients were at greater risk of suicidal behavior. First and second generation antipsychotics were not distinguished.


CONCLUSIONS
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.
Yerevanian
Boghos I
BI
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. byerevan@ucla.edu
Koek
Ralph J
RJ
Mintz
Jim
J
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use; D014728:Veterans / Q000523:psychology*; D000092864:Suicide Prevention
D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid