Suicide attempts amongst elderly bipolar patients

Background: Bipolar disorder is associated with high risk of suicide. In the elderly suicide rates are the highest of all age groups. There is a paucity of data regarding suicide amongst elderly bipolar patients. Mood stabilizers and particularly lithium are established as "antisuicide" compounds. Objective: We aimed to evaluate the association between exposure to psychotropic drugs and suicide attempts in a cohort of elderly patients suffering from bipolar affective disorder (BAD). Method: This was a preliminary, retrospective, matched, case-controlled evaluation over a 10-year period. All records of admissions of patients with BAD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The control group consisted of the next admission of a patient suffering from BAD, matched for sex and age who had not attempted suicide in the month prior to admission. Results: The index group during the period 1995 to 2004 consisted of 16 patients, (8 men and 8 women.), mean age 74.8 ± 1.3 years. The control group patients (N = 16) were matched for age (mean 74.3 ± 1.5 years) and sex. The number of patients who had a history of a suicide attempt was significantly greater in the index group (7 / 16 vs., 2 / 16; p = 0.039). In the control group patients treated by both a mood stabilizer and an antidepressant were at a significantly lower risk for recent suicide attempt (p = 0.047). Limitations: Sample size is small, treatments were not standardized and data were collected retrospectively. Conclusion: Elderly BAD patients treated with mood stabilizers and antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.