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Placebo-controlled clinical trials have led to concern over possible
increased risk of suicide-related events in some populations exposed to
To evaluate the risk of suicide attempts by antidepressant drug class and
the presence or absence of depression.
A retrospective propensity-matched new-user cohort study was used to
compare participants with incident depression classified by
antidepressant treatment with each other and with the general
Among the treated group, the suicide attempt rate peaked in the month
prior to diagnosis then decreased steadily over the next 6 months. Among
the pharmacologically untreated group, the highest rate was seen in the
second month after diagnosis. Cohorts with depression had significantly
higher suicide attempt risk than the general population, but the treated
group did not differ significantly from the untreated group.
Patients on antidepressants did not have significantly higher risk
compared with untreated patients. No significant differences were
observed for patients treated with individual serotonin–noradrenaline
reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors
(SSRIs) or by class (SSRI v. SNRI cohorts).
The impact of anxiety disorders has not been well delineated in prospective studies of bipolar disorder.
To examine the association between anxiety and course of bipolar disorder, as defined by mood episodes, quality of life and role functioning.
A thousand out-patients with bipolar disorder were followed prospectively for 1 year.
A current comorbid anxiety disorder (present in 31.9% of participants) was associated with fewer days well, a lower likelihood of timely recovery from depression, risk of earlier relapse, lower quality of life and diminished role function over 1 year of prospective study. The negative impact was greater with multiple anxiety disorders.
Anxiety disorders, including those present during relative euthymia, predicted a poorer bipolar course. The detrimental effects of anxiety were not simply a feature of mood state. Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course.
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