Bipolar pharmacotherapy and suicidal behavior. Part 2. The impact of antidepressants

Boghos I. Yerevanian, Ralph J. Koek, Jim Mintz, Hagop S. Akiskal

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Antidepressant-induced mania and cycle acceleration is a potential risk in bipolar patients. Another serious risk of antidepressants, that of increasing suicidal behavior, has been identified in some affectively ill populations. However, there is a dearth of knowledge about the effects of antidepressants on suicidal behavior specifically in bipolar patients. Methods: Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month by month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Chi-squared comparison of (log) rates of suicidal events during mood stabilizer monotherapy, antidepressant monotherapy, and combination of mood stabilizer and antidepressant. Results: Suicidal behavior event rates (per 100 patient years) were greatest during treatment with antidepressant monotherapy (25.92), least during mood stabilizer monotherapy (3.48), and intermediate during mood stabilizer + antidepressant combination treatment (9.75). These differences were statistically significant. Limitations: In a clinical setting, antidepressants may have been prescribed because patients were deemed at greater risk of suicidality. Conclusions: During treatment with antidepressants (even when coupled with mood stabilizers), patients with bipolar disorder have significantly higher rates of non-lethal suicidal behavior compared to those on mood stabilizers without antidepressants, and thus require careful monitoring.

Original languageEnglish (US)
Pages (from-to)13-21
Number of pages9
JournalJournal of Affective Disorders
Issue number1-3
StatePublished - Nov 2007
Externally publishedYes


  • Antidepressants
  • Bipolar disorder
  • Longitudinal study
  • Public health
  • Suicide
  • Suicide attempt
  • Veterans

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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