title: Suicidal Behavior in Mood Disorders: Response to Pharmacological Treatment.
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.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA. ltondo@mclean.harvard.edu.|International Consortium for Bipolar Disorder Research, McLean Hospital, 115 Mill Street, Belmont, MA, 02478-9106, USA. ltondo@mclean.harvard.edu.|Lucio Bini Mood Disorder Centers, Cagliari and, Rome, Italy. ltondo@mclean.harvard.edu.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tondo
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA.|International Consortium for Bipolar Disorder Research, McLean Hospital, 115 Mill Street, Belmont, MA, 02478-9106, USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D001526:Behavioral Symptoms / Q000175:diagnosis / Q000188:drug therapy; D004358:Drug Therapy / Q000379:methods*; D006801:Humans; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D011619:Psychotropic Drugs / Q000145:classification / Q000494:pharmacology; D020379:Risk Adjustment; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention
chemical_list: D011619:Psychotropic Drugs
keywords: Anticonvulsants; Antidepressants; Antipsychotics; Bipolar I and II disorders; Lithium; Major depressive disorder; Suicide