Tuesday, June 22, 2004

Suicide and antidepressants

One of the things Mark A. R. Kleiman and Easterbrook neglects in their discussions about suicide and antidepressants is the undiagnosed bipolar disorder issue.

Bipolar disorder in individuals require careful management, both at the personal level and at the pharmacological level. Meaning: if you have bipolar disorder, it's vital to have a psychiatrist who will monitor you well because it's difficult to gauge proper medication levels and type.

One major thing to know about bipolar disorder is that antidepressants can (not always) induce a manic state: involves a very specific array of stuff including extremely poor judgment, impulsive and compulsive behaviors, and many many other symptoms including increased suicidal ideation in some. There are other details; please please please do not self-diagnose on the basis of these few things I mention.

I'm not saying this bipolar thing is the one and only reason why suicide is a problem. But this is one important consideration and a problem with the system when you have GP's giving out psychiatric meds. The problems include the need for proper diagnosis, monitoring, and followup. GP's do not have the training or the time to do this especially in the managed care system.