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To the Editor: In their Review article on suicide prevention strategies, Dr Mann and colleagues¹ conclude that recognition of depression and restricted access to lethal methods can reduce suicide rates. Less information is provided about suicidal patients with disorders other than major depression and treatments other than antidepressants. Notably, in bipolar disorder, the risk of suicide is at least as high as in unipolar depression.² Evidence for reduced risk of suicide and suicide attempts in bipolar and other mood disorders during long-term treatment with lithium is abundant, consistent, and compelling, including data from randomized, controlled trials.^3-5 Moreover, such efficacy of lithium may exceed that of anticonvulsants with antimanic or proposed mood-stabilizing effects.^3-4

Given the strong association between clinical depression and suicide, it is puzzling that information pertaining to reduction of suicidal risk with antidepressant treatment remains inconsistent and inconclusive.⁵ Ecological analyses have found correlations between reductions in suicide rates and . . . [Full Text of this Article]

Leonardo Tondo, MD; Ross J. Baldessarini, MD
rjb@mclean.org
Department of Psychiatry
Harvard Medical School
Boston, Mass

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