Psychotropic Medication Trends Before and After Suicide Attempt Among Mid-to Late Life U.S. Veterans With Bipolar...

Characterize psychotropic medication use before and after attempted suicide among individuals with bipolar disorder (BD).

Retrospective cohort study.

U.S. Veterans Health Administration.

Patients with BD aged 50 years and older without prior known suicide attempt. We matched patients who attempted suicide between October 2011 and December 2019 to similar patients who did not attempt suicide in a 1:1 ratio.

Psychotropic medication use, overall and by therapeutic class (antidepressants, antiepileptics, antipsychotics, benzodiazepines, lithium, opioids, and sedative-hypnotics), and polypharmacy.

Our final sample included 4,747 individuals who attempted suicide and 4,747 matched controls. The mean age at index was 60.5, and 86% were male. Psychotropic medication use was consistently greater among those attempting suicide than their matched counterparts for all medication classes examined, except opioids. In the 6 months following suicide attempt, there were large and abrupt increases in use of antipsychotics, antiepileptics, lithium, and sedative-hypnotics, with smaller increases in antidepressants and benzodiazepines, and reductions in opioids. However, by the end of the first year after the attempt, the prevalence of polypharmacy, opioid use, and benzodiazepine use decreased to slightly below, but generally similar to baseline levels, and use of antidepressants, antiepileptics, and antipsychotics largely returned to baseline.

Suicide attempts were associated with short-term increases in antipsychotics and antiepileptics and long-term decreases in opioids and benzodiazepines. These changes may reflect clinical intention to stabilize bipolar depressive symptomology while limiting future suicide capacity via high-risk medications.