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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 2012 December;53(4):277-88


language: English

Depression and suicide. An update

Rihmer Z. 1, 2

1 Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary; 2 Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary


The risk of self-destructive behavior in mood disorders is an inherent phenomenon and suicidal behavior in patients with unipolar or bipolar major mood disorders strongly relates to the presence and severity of depressive episode. The early recognition and appropriate treatment is important, since out of all psychiatric illnesses (untreated) depressive disorders carry the highest risk of both attempted and completed suicide. Suicidal behavior in patients with mood disorders is state and severity dependent that means that suicidality markedly decreases or vanishes after clinical recovery. However, since the majority of mood disorder patients never commit and more than half of them never attempt suicide, special clinical characteristics of the illness as well as some personality, familial and psycho-social factors should also play a contributory role. Considering the clinically explorable suicide risk factors in patients with major mood disorders (family and/or personal history of suicidal behavior, early onset of mood disorder, severe depressive episode/hopelessness, agitated/mixed depression, bipolar I or II diagnosis, rapid cycling, comorbid Axis I and Axis II disorders, adverse life situations, lack of social and medical support, cyclothymic temperament, impulsive aggressive personality features, etc.), suicidal behavior is predictable with a good chance. There are also several pieces of evidence that successful acute and long-term pharmacotherapy markedly reduces the risk of attempted and completed suicide, even in this high-risk population. Recent studies also show that supplementary psycho-social interventions (psychoeducation, and targeted psychotherapies) further improve the results.

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