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

J Affect Disord. 2007 Nov;103(1-3):13-21. doi: 10.1016/j.jad.2007.05.017. Epub 2007 Jul 6.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Bipolar Disorder / chemically induced
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / epidemiology
  • Drug Therapy, Combination
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Suicide / prevention & control*
  • Suicide / statistics & numerical data
  • Suicide, Attempted / prevention & control*
  • Suicide, Attempted / statistics & numerical data
  • Veterans / psychology*


  • Anticonvulsants
  • Antidepressive Agents