Is there any evidence pharmacotherapy reduces suicidality in bipolar disorder?
As noted earlier, we found no published prospective, randomized, controlled study of an antidepressant in bipolar disorder that evaluated suicidality as a primary outcome measure. Indeed, bipolar patients with clinically significant suicidality have generally been excluded from pharmacotherapy trials. Moreover, most controlled studies of antidepressants in bipolar disorder did not use suicidality measures as secondary outcome scales or separately report changes on values of suicidality items from depressive symptom scales (29, 30, 43, 44, 88–98). Thus, very few controlled data have empirically addressed the effects of antidepressants upon suicidal ideation, suicidal behavior or suicide in persons with bipolar disorder. One important exception is the placebo-controlled comparison of olanzapine and the combination of olanzapine and fluoxetine (OFC) in 833 patients with bipolar type I depression carried out by Tohen et al. (36). In this 8-week study, olanzapine was found to be superior to
