Charles L. Rich

Antidepressant treatment and the occurrence of mania in bipolar patients admitted for depression

We examined the records of 33 patients who had 70 inpatient admissions with a diagnosis of bipolar affective disorder, depressed. During 14 of these admissions, a switch occurred from depression into mania. We compared the treatment patients were on at the time of their switch to treatment during the 56 admissions where there was no switch. We conclude that clinicians must be prepared for depressed bipolar patients to switch to mania regardless of treatment status.

Diagnostic comorbidity of mental disorders among young suicides

Depressive and substance use disorders predominate in the psychopathological backgrounds of suicides of all ages. In five published studies of consecutive suicides by adolescents and young adults, the average reported rates are 41% for major depression and 48% for substance abuse. Personality disorders (PDs) have been less consistently reported with rates varying from 10% to 34% among young suicides. These consist almost exclusively of Borderline (BPD) and Antisocial Personality Disorders (ASPD). “Pure” PDs are rare because of comorbidity with major depression and substance abuse. Follow-up studies of patients with PDs also report similar comorbidity among those who die by suicide. We discuss several hypothetical explanations for this observed comorbidity. Regardless of the explanations, though, the combinations of BPD and ASPD with depressive and/or substance use disorders must be viewed with great caution for their lethal potential.