Tuesday 2 October 2018

Bipolar disorder and "completed suicide"

"Suicide rates in BD [bipolar disordervary between studies but our analyses show that they are approximately 20-30-fold greater than in general population."

That rather sober sentence comes from the results of the systematic review published by Plans and colleagues [1] looking at "the existing literature of completed suicide in BD patients." As per the words 'completed suicide' this was a review article specifically focused on looking at studies examining the very final decision taken to end ones life and acting upon it. The authors did look at "suicide attempts and suicidal behaviour" during the course of their review but only in the context of completed suicide.

Then to the cold, objective science... over 60 articles met the authors inclusion criteria and allowed researchers to review "epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD." Aside from the quite startling risk of completed suicide in relation to a diagnosis of bipolar disorder, authors were also able to note some important risk variables too: "early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities." Another important statement was also made pertinent to that 'treatment' analysis: "Lithium is the only treatment that has shown anti-suicide potential" in line with other observations (see here).

What's more to say? Well acknowledging that the paths towards suicide are various and numerous (see here) and, more often that not, influenced by both internal and external factors, the connection between bipolar disorder and suicide risk is cemented by the Plans review. I could talk about how bipolar disorder and other depression-related illnesses (yes, illnesses) are potentially *connected* to various other diagnostic labels (see here for example) and, within that context, may very well influence suicide risk there too (see here). But there's nothing particularly novel about such discussions.

The 'lithium' bit to the Plans paper is also important to reiterate, and how such medication is truly a life-saver for some. As with all medicines, it does have a 'risk profile' [2] but, with appropriate monitoring, any side-effects need to be balanced against the very real risk highlighted by Plans et al.

And then there is the need for lots more scientific investigation in this area to directly 'tackle' bipolar disorder in terms of aetiology and pathology and logically onward, to impact on suicide risk...

To close, there are people to talk to (or text) if needed...


[1] Plans L. et al. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord. 2018 Aug 23;242:111-122.

[2] Albert U. et al. Lithium treatment and potential long-term side effects: a systematic review of the literature. Riv Psichiatr. 2014 Jan-Feb;49(1):12-21.


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