Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

Abstract

Objectives Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. Methods Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. Results The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4–14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23–26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. Conclusion This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…Suicide is one of the leading causes of death in BD, with approximately 6%‐7% of identified patients with BD dying by suicide; thus, suicide risk is substantially higher in BD than in the general population (10.7 per 100 000 per year) 46, 47. The fatality of suicide attempts is also higher in BD than in the general population 48, 49.…”

“…Only male sex and first‐degree family history of suicide have been significantly associated with suicide deaths 50, 51. The periods during and following hospital admission further represent times of particularly high risk, with 14% of suicides occurring during an inpatient stay and another 26% within 6 weeks of discharge 47, 52…”

“…There were limited data on both antipsychotics and antidepressant agents 47. As the most common method of suicide in this population is self‐poisoning, the potential benefits of various treatments should be considered against their risk of toxicity and lethality.…”

“…Principles related to management of suicidal ideation and risk (see Section 2 and47) are of utmost importance during depressive episodes, as >70% of suicide deaths and suicide attempts in patients with BD occur during this phase 230, 231. Depressive episodes with mixed features are a particularly dangerous period associated with even higher short‐term risks of suicide attempts or death 232.…”

Psicofarmacología del suicidio II parte: Estabilizadores del ánimo y suicidio

“…Los posibles mecanismos de acción específicos para el litio se citan en Tabla 1. 33 . Empero, una serie de estudios han demostrado efectos contrarios en este tipo de drogas.…”