Bipolar disorder and suicide: research synthesis and clinical translation.
Attempted suicide and suicide are prevalent in individuals with bipolar disorder (BD). Extant evidence indicates that history of suicide attempts, percentage of time spent in a depressed state, and hostility are factors associated with suicide attempts and completed suicide. Childhood adversity (eg, sexual and physical abuse) is emerging as a risk factor for suicide attempts in adults with BD. The pertinacity of medical comorbidity (eg, obesity, metabolic syndrome) in the bipolar population is further underscored by its preliminary association with suicidality. Biomarkers such as cerebrospinal fluid monoamine metabolite levels may be predictive of suicide attempts and lethality in BD. Compelling evidence supports an antisuicide effect of long-term lithium prophylaxis; lithium's salutary effect is mediated primarily by reduced lethality of suicidal acts. Conventional unimodal antidepressants may engender or exacerbate suicidality in susceptible individuals with BD. A nascent database suggests that adjunctive psychosocial interventions may further reduce suicide risk in bipolar individuals.
McIntyre
Roger S
RS
Department of Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. roger.mcintyre@uhn.on.ca
Muzina
David J
DJ
Kemp
David E
DE
Blank
Diana
D
Woldeyohannes
Hanna O
HO
Lofchy
Jodi
J
Soczynska
Joanna K
JK
Banik
Suman
S
Konarski
Jakub Z
JZ
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001714:Bipolar Disorder / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D002423:Cause of Death; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D011613:Psychotherapy; D012106:Research; D012306:Risk; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D016019:Survival Analysis; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D018692:Antimanic Agents; D015415:Biomarkers; D016651:Lithium Carbonate; D006897:Hydroxyindoleacetic Acid