Suicidal ideation and bipolar-II depression symptoms


  • Franco Benazzi

    Corresponding author
    1. E. Hecker Outpatient Psychiatry Center, Ravenna, Italy, A University of California at San Diego, USA, Collaborating Center, and Department of Psychiatry, National Health Service, Forli, Italy
    • Via Pozzetto 17, 48010 Castiglione di Cervia RA, Italy.
    Search for more papers by this author



The FDA issued a warning about a possible risk of suicidal behaviour related to ‘newer’ antidepressants. Suicidal behaviour is common in bipolar-II (BP-II) depression, which is frequent in outpatients, and often mixed (i.e. it has concurrent hypomanic symptoms). The study aim was to find major depressive episode (MDE) and intra-MDE hypomanic symptoms associated with suicidal ideation.


A total of 374 consecutive BP-II MDE outpatients were interviewed by the structured clinical interview for DSM-IV (SCID), the hypomania interview guide, and the family history screen.


Suicidal ideation was present in 52.6%. Suicidal ideation and lower GAF (meaning more severity), more persistent MDE symptoms, more melancholic depressions were significantly associated. Multiple logistic regression of suicidal ideation versus MDE symptoms and intra-MDE hypomanic symptoms found, as significant independent predictors, decreased self-esteem, racing/crowded thoughts, psychomotor agitation.


As expected, suicidal ideation and depression severity were associated. Racing/crowded thoughts and psychomotor agitation were independent predictors of suicidal ideation. While cross-sectional associations cannot show a causal association, some evidence from prospective studies supports the direction of the association. As BP-II depression is common and often mixed in outpatients, clinicians should assess intra-MDE racing/crowded thoughts and psychomotor agitation, as antidepressants alone may worsen these symptoms, and this may induce or increase suicidal behaviour. Mood stabilizing agents may be needed to control these excitement symptoms before using antidepressants. Copyright © 2004 John Wiley & Sons, Ltd.