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Depressive First Episode In Bipolar Disorder Increases Suicide Risk
The wide variety of symptoms experienced by patients with bipolar disorder complicates their care and management, especially with regard to preventing and predicting the risk of suicide. A recent paper by a group of researchers at the New York State Psychiatric Institute found a correlation between suicidal tendencies and bipolar patients who have depressive first episodes. “Regression analysis showed that first mood episode polarity was strongly associated with past suicide attempt with an odds ratio greater than eight,” says Michael Grunebaum, M.D., assistant professor of clinical psychiatry. “This is over and above any contribution of the number of years of illness or lifetime number of depressive episodes.”
   Predicting the risk of suicide is of critical importance for patients with bipolar disorder, but because of the many sub-types of the disease, physicians may encounter considerable difficulty. Evidence indicates that nearly 30 percent of those afflicted with bipolar disorder will attempt suicide, and these patients are most at risk for doing so during depressive episodes and dysphoric mania. Dr. Grunebaum and his colleagues found that patients who experienced a depressive first episode made twice as many suicide attempts as those who had manic first episodes.
   “Although the more ‘manic-prone’ sub-group had a more severe course in some ways, such as more psychosis, these subjects nonetheless reported more reasons for living and were less likely to have made a suicide attempt,” Dr. Grunebaum says. “This might suggest, in a more speculative way, that there is some constitutionally depressive factor, pre-dating the accumulated burden of years ill and number of depressive episodes, that is related to suicide attempts in these patients with first episode depression.”

Journal of Affective Disorders 104 (2007) 245-250
Supported by Pharmacotherapy of High-Risk Bipolar Disorder grant from the NIMH, the Conte Neuroscience Center and the Stanley Medical Research Institute. Dr. Grunebaum is supported by NIMH, NARSAD, and investigator-initiated support from GlaxoSmithKline unrelated to this study.

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