Mixed Depression, Suicidality, and Antidepressants

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Sir: The important article by Bauer et al.¹ showed no association between antidepressants and suicidality in bipolar depression. However, among the correlates of suicidality, intradepression manic symptoms at intake, before antidepressant treatment was started, increased the odds ratio of suicidality to 1.62. The article seems to underplay this important finding, given the recent warning of the U.S. Food and Drug Administration (FDA)² about the need to monitor patients during antidepressant treatment for the emergence of possible precursors to suicidality, including manic symptoms such as irritability and psychomotor agitation, which are common intradepression manic symptoms.’ ‹