The article “suicide risk in mood disorders” by Zoltan Rihmer aims at highlighting the traditional and modern suicidal risk factors which have been recognized in people with mood disorders. Suicidal risk behavior has increased in individuals with mood disorders, and it is related to people having severe depressive episodes. The suicidal behavior in people with mood disorders is a state whose severity depends on some factors indicating that suicidal behavior may vanish or reduce after patients undergo treatment. Factors such as personality, family, psycho-social factors and special clinical features of mood disorder contribute to suicidal behavior. Other risk factors include the onset of mood disorder, severe depression episode, agitation, bipolar 1 and diagnosis 2, adverse life situations and inadequate social and medical support. This article explains the traditional and modern factors which contribute to suicidal behavior in people with mood disorders.
According to Rihmer, psychological study autopsy shows that 90% of suicide victims have untreated Axis 1 and central psychiatric disorders. Central depression episodes have been frequent in suicidal cases with 56-87% of suicide victims having severe depression cases. People committing suicide due to substance use problems have been identified to be 26-55%, and 6-13% commit suicide due to schizophrenia (Rihmer, 2007). Although anxiety and personality issues are factors which contributes to suicidal cases, suicidal cases reported due to these factors are rarely ranging between 3-7% (Rihmer, 2007). These studies indicate that suicidal behavior in people with mood problems is dependent on both internal and external factors. Therefore, suicide can be effectively prevented through treating acute mood episodes and the period of euthymia should also be stabilized to avoid cases of suicide. Rihmer indicate that most of the patients with mood disorder do not commit suicide and half of the never have the thought of attempting suicide. This suggests that factors such as familial, psychological and clinical characteristics are responsible for increasing cases of suicidal risk among patients with mood disorders. This aim of this article review is to explain the most and recent known findings of suicidal risk factors common among patients with mood disorders primarily in the current arising debate on how suicidal behavior relates with medication of antidepressants.
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Suicidal Risk Factors in Patients with Mood Disorders
Suicidal behavior showing individuals with mood disorders is usually dependent phenomenon. Most of the suicidal risk factors are linked with the mood episodes.
Risk Factors Related To Current or Past Episodes
Most of the suicidal risk factors among individuals with mood disorders are significantly linked with mood episodes and also known as proximal factors. Patients who have minor depression and dysthymia with minor depression do not fall victims of suicidal or attempting suicide. Severe depression especially when the affected individual lacks hope and is full of guilty is the main factor causing suicide among people with mood disorders. Rihmer indicates that the cases of suicide are high in hospitalized patients with mood disorders especially during the time of admission into the hospital and the time of discharge and occurs mostly when treatment administered in a short period. According to Rihmer (2007), patients with bipolar and unipolar types of mood disorders are the highest recorded in suicide cases and attempted suicides. The study showed that patients with bipolar 11 mostly attempt and commit suicide with bipolar 11 having 25% and bipolar 1 16% (Rihmer, 2007). However, the study indicates that unipolar patients are more likely to attempt and commit suicide with 14% than the bipolar patients with 8% (Rihmer, 2007).
Major depressive episodes can be mixed with the three or two states of depression occurring co-currently with reports indicating that attempts and suicides were high in mixed states than unmixed states in patients with depression. According to research patients with depression attempting suicide, 63% of the patients had mixed depression, 71% of the patients tried to commit suicide. 90% of the patients with mixed depression suffered from irritability, psychomotor agitation and distractibility (Rihmer, 2007). The data indicate that most of the patients with mood disorders attempting suicide are those with bipolar and unipolar depression states hence it supports the role mixed depression plays in causing suicidal behavior. According to a study carried out on adolescents, girls are reported to have a high risk of committing suicide due to mixed depression.
Symptoms of mixed depression among patients with mood disorders indicated that there is a significant relationship between psychomotor activation, racing thought, and suicidal ideation. This implies that agitated depression should be categorized as a state of mixed bipolar depression. Therefore, agitation can be classified as a suicidal risk factor in people with mood disorders. The study also focuses on the role mood disability plays in increasing risk of suicidal behavior among individuals with mood disorders. Reports indicate that mood switching and panic attacks are associated with growing suicidal thoughts among patients of mood disorders. Cyclothymia is characterized by frequent, persistent, thinking and behavior as well as mood instabilities in patients. Cyclothymia has been discovered to be a suicidal factor because study noted that cyclothymic personality was highly related to lifetime and increase of suicidal behavior both attempts and suicide acts.
Discovery of the essential role pseudo-unipolar mixed depression states in suicidal behavior has indicated that suicide can be prevented among patients with mood disorders. The appropriate identification of converting the bipolar state of a particular depression episode is essential in choosing the proper treatment. However, some practices such as the use of antidepressant monotherapy, antipsychotics to patients with unipolar and bipolar depression states and mood stabilizers only worsen the state of depression and suicidal behavior as well as forms treatment resistance on the patients. Other factors increasing suicidal risk behavior include anxiety disorder, comorbid substance, and concomitant severe medical infections. Mania is another disorders noted to increase the risk of attempted and committing suicide. However, the two states of mania have different capabilities of causing suicidal behavior with euphoric mania creating 40% among the patients and pure mania causing 10% (Rihmer, 2007).
Risk Factors Unrelated To Current or Past Mood Episodes
Factors which are well recognized in causing suicidal behaviors but are not related to past mood episodes include psychosocial and familial factors. Family history and childhood experiences are factors which can cause suicidal behaviors among individuals with mood disorders. Family factors which contribute to suicidal behaviors include childhood experiences such as parent loss or physical, emotional or sexual assaults, early start of mood disorder, aggressive and impulsive individual characters and adverse life conditions like lack of employment. Although men are most affected victims of suicide compared to women, gender cannot be used in predicting attempted and suicides committed among bipolar and unipolar mood states.
Depressions, Suicide, and Antidepressants
The significant prevention for suicidal behavior among individuals with mood disorders is the use of depression pharmacotherapy such as mood stabilizers, anxiolytics, antidepressants, and antipsychotics. The widespread antidepressant use across the world has significantly reduced suicidal rates especially in nations with a traditional history of suicidal cases. However, antidepressants especially monotherapy can increase depression hence contributing to increasing of suicidal behaviors in the community. According to Rihmer (2007), when antidepressants increase depression, chances of the affected individual to develop agitation, excitement and mental anxious is high, increasing the risk of suicidal behavior. Therefore, antipsychotics, concomitant mood stabilizers should be used in reducing the development of hetero-aggressive and auto-aggressive consequences.
Conclusion
Although suicide is a rare case in society, it is common mostly in people with mood disorders who are in contact with different types and levels of health treatment. Though it is difficult to prevent all suicides, use of effective acute and prolonged treatment of both bipolar and unipolar depression states can reduce suicide cases. Many people with mood disorders have committed suicide, and others attempted suicide, and therefore, it is essential to understand suicidal risk factors in individuals with mood disorders early and intervene before the affected individual thinks of committing suicide. Effective and widespread treatment of both bipolar and unipolar depression can reduce suicidal mortality in patients with mood disorders. Remarkable progression is being made in departments dealing with depression management such as hypertension to help in lowering the causes of suicide behaviors. The exploration of traditional and modern suicidal risk factors among people with mood disorders helps doctors and physicians in identifying patients developing suicidal behaviors.
Reference
Rihmer, Z. (2007). Suicide risk in mood disorders. Current opinion in psychiatry, 20(1), 17-22.
