Suicide attempts amongst elderly bipolar patients

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.

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).

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.

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).

Sample size is small, treatments were not standardized and data were collected retrospectively.

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.