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September 17, 2003

Suicide Risk and Treatments for Patients With Bipolar Disorder

Author Affiliations

Author Affiliations: Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, Mass (Drs Baldessarini and Tondo); Bipolar and Psychotic Disorders Program and International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont (Drs Baldessarini and Tondo); Centro Bini–Stanley Medical Research Institute and Department of Psychology, University of Cagliari, Cagliari, Italy (Dr Tondo).

JAMA. 2003;290(11):1517-1519. doi:10.1001/jama.290.11.1517

Bipolar disorder, one of the most common severe mental illnesses, includes type 1 (with mania and usually recurrent depression) and type 2 (recurrent major depression with hypomania).1,2 Lifetime prevalence for type 1 bipolar disorder is approximately 1%, but inclusion of more broadly defined conditions increases this rate to 2% to 5%.3 Bipolar disorder can begin in childhood or adolescence,4 continues throughout life, and is extraordinarily costly—financially as well as clinically and socially.5 The course of bipolar disorder is episodic but highly variable, with potential for high levels of severity and recurrence intensity, disproportionately high depressive morbidity, and comorbidity with substance abuse and anxiety disorders.3 Bipolar depression can be present during 20% to 30% of patients' time, even during prophylactic treatment,6-8 and is closely associated with disability and mortality.3,9,10 Bipolar disorder proves fatal in a high proportion of patients from complications of risk-taking behavior, comorbid stress-sensitive medical illnesses, and especially suicide.3,9,10 These characteristics mark bipolar disorder as a major unsolved public health challenge.