Impact of psychotropic drugs on suicide and suicidal behaviors
Version of Record online: 19 JUL 2013
Published 2013. This article is a U.S. Government work and is in the public domain in the USA
Special Issue: Guest Editors – Frederick Cassidy and Christopher Baethge
Volume 15, Issue 5, pages 594–621, August 2013
How to Cite
Impact of psychotropic drugs on suicide and suicidal behaviors. Bipolar Disord 2013: 15: 594–621. Published 2013. This article is a U.S. Government work and is in the public domain in the USA., .
- Issue online: 6 AUG 2013
- Version of Record online: 19 JUL 2013
- Manuscript Accepted: 25 MAR 2013
- Manuscript Received: 3 OCT 2011
- bipolar disorder;
- mood disorder;
- psychotropic drugs;
- sedatives and hypnotics;
To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders.
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.
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.
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.