Antipsychotics and Suicidal Behavior

Bipolar disorder treatment with atypical antipsychotics may have lower risk of suicide

(RxWiki News) Bipolar disorder is sometimes treated with antipsychotic medications. First and second generation antipsychotics have different side effects, but do they have the same suicide risk?

Recent research found that rates of suicide events were lower for the second generation antipsychotics compared to first generation antipsychotics when an antipsychotic was the only medication being taken for bipolar symptoms.

"Talk to your psychiatrist about any thoughts of self-harm."

A study led by Ralph J. Koek, MD, of the University of California, Los Angeles, looked at the charts of 161 veterans with bipolar disorder who sought treatment at a Veterans Affairs hospital.

The researchers reviewed the charts for use of antipsychotics and suicidal events, which were suicide attempts, completed suicide and hospitalization to prevent suicide.

They compared the numbers of suicide events in people that used first generation antipsychotics like haloperidol to people who used newer second generation antipsychotics like risperidone.

First generation antipsychotics, also called typical antipsychotics, are effective in treating schizophrenia and other approved conditions but may produce symptoms similar to those found in Parkinson’s disease, known as tardive dyskinesia.

Second generation antipsychotics, also called atypical antipsychotics, are also effective but carry lower risk for tardive dyskinesia.

Dr. Koek and colleagues found that the rate of suicidal events was about one per year in the group of people taking first generation antipsychotics. In the group of people taking second generation antipsychotics, the rate was about one event every five years.

When the researchers looked at the suicide event rates for people taking an antipsychotic and a mood stabilizer, like lithium, they found that the rates of suicidal events were identical for first and second generation antipsychotics.

The researchers concluded that second generation antipsychotics, taken without a mood stabilizer for the treatment of bipolar disorder, are linked to fewer suicide events.

However, the study has some limitations. There were relatively few suicide events in the chart records and no completed suicides. They looked at male veterans only, and the chart review does not allow for any real-time tracking of suicidal thoughts or behaviors.

This study was published on June 30 in the Journal of Affective Disorders. Financial disclosures from the authors were not available.

Review Date: 
July 10, 2012