Impact of psychotropic drugs on suicide and suicidal behaviors

Authors

  • Boghos I Yerevanian,

    Corresponding author
    1. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
    • Department of Psychiatry, Greater Los Angeles VA Healthcare System, Sepulveda Ambulatory Care Center, North Hills, CA, USA
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  • Young Mee Choi

    1. Department of Psychiatry, Greater Los Angeles VA Healthcare System, Sepulveda Ambulatory Care Center, North Hills, CA, USA
    2. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Corresponding author:

Boghos I. Yerevanian, M.D.

Department of Psychiatry

Greater Los Angeles VA Healthcare System

Sepulveda Ambulatory Care Center

16111 Plummer Street

Building 10, MC 116A3

North Hills, CA 91343

USA

Fax: 818-876-0546

E-mail: byerevan@ucla.edu

Abstract

Objective

To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders.

Methods

A Medline search of articles published from January 1960 to January 2013 was performed using relevant keywords to identify studies examining the relationship of psychotropic drugs to suicidal behaviors. The publications were further reviewed for relevant references and information. Additionally, the US Food and Drug Administration Center for Drug Evaluation Research website was searched.

Results

The available studies used differing methodologies, making interpretation of the findings difficult. Studies suggest that antidepressants may increase suicidal risk in bipolar disorder, this possibly being related to the induction of broadly defined mixed states. There is no evidence that antiepileptic drugs as a class increase suicidal risk in patients with bipolar disorder. Only lithium provides convincing data that it reduces the risk of suicide over the long term. There is little known regarding the effects of antipsychotics, as well as anti-anxiety and hypnotic drugs, on suicidal behavior.

Conclusions

The available evidence for the impact of psychotropics on suicidal risk in patients with bipolar disorder is largely methodologically flawed and, except for a few instances, clinically not useful at this point. Adequately powered, prospective randomized controlled studies are needed to assess the impact of each class of psychotropic and each psychotropic as well as common combination therapies. Until such studies have been carried out, clinicians are urged to exercise caution in using these drugs and rely on the traditional means of carefully assessing and monitoring patients with bipolar disorder who are at high risk for suicide.

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