BMJ  2007;334:327 (17 February), doi:10.1136/bmj.39121.846667.1F

Letters

Suicide risk

Bipolarity is important during treatment with antidepressants

The first 150 words of the full text of this article appear below.

Rubino et al have identified that most (if not all) of the excess risk of suicide in a group of patients treated with venlafaxine could be explained by a higher burden of risk factors for suicide.¹ It may be true that this group of patients had more severe or "difficult to treat" unipolar depression, but it is also possible that bipolar features in this group may be responsible for the observed raised rates of suicidality. Perhaps because of limitations of space, the authors do not discuss this as a possibility, despite an adjusted relative risk of completed suicide of 4.94 (95% confidence interval 1.30 to 18.84) for "past history of bipolar disorder" (table 3).¹

Recent work shows that at least 50% of difficult to treat unipolar depressed patients may have an undetected bipolar disorder,² and it is now well documented that antidepressant monotherapy for bipolar depression runs a high risk . . . [Full text of this article]

Cardiff University, Cardiff CF14 4XN

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