Suicide Risk 10-Fold Higher in Women With Fibromyalgia

[Guest guest]

Hmmmm I wonder  if they took cholestyramine to help detox those free radicals

and toxins that cause inflammation and a little Beta reset for the brain stem,

how many of those could have been avoided?   All ??

Suicide Risk 10-Fold Higher in Women With

Fibromyalgia

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October 15, 2010 — Women with fibromyalgia have a 10-fold increased

risk for suicide and are also at increased risk for liver disease and

cerebrovascular disease, Danish researchers report in the October issue of

Arthritis & Rheumatism.

Drawing on Danish hospital and mortality data, Lene Dreyer, MD, PhD,

and colleagues found that although overall mortality among patients with

fibromyalgia was not increased, there were increased risks for women. This was

the first prospective study of mortality in fibromyalgia to include a clinical

examination at the hospital, a blinded review of the diagnosis according to

American College of Rheumatology criteria, data from a complete national death

registry, and up to 16 years of follow-up.

" The suicide risk was increased at the time of diagnosis and remained

increased after 5 years, " the authors write.

The 84 male patients included

did not have increased cause-specific mortality.

The analysis showed that among the 1269 female patients with

fibromyalgia, the standardized mortality ratios were 10.5 for death from

suicide, 6.4 for death from liver cirrhosis or biliary tract disease, and 3.1

for death from cerebrovascular disease. After a mean follow-up of 3.9 years,

there had been 48 deaths observed among 1353 patients (84 men, 1269 women). The

41 deaths among 1269 women with fibromyalgia included 8 from suicide, 8 from

cancer, 6 from liver cirrhosis/biliary tract disease, 6 from cerebrovascular

disease, 4 from chronic obstructive pulmonary disease, 3 from other heart

disease, 2 from other causes, and 1 each from ischemic heart disease, pneumonia,

mental disorders, and other external causes.

Immediate Clinical Implications

This study has immediate clinical implications, expert say.

" Risk factors for suicide should be sought at the time of the diagnosis

of [fibromyalgia] and at follow-up. The results also suggest that risk factors

for liver disease and cerebrovascular disease should be evaluated in patients

with [fibromyalgia], " Dr. Dreyer, who is at Copenhagen University Hospital in

Denmark, and colleagues write.

The authors suggest that the increased risk for suicide might be

related to increased rates of lifetime depression, anxiety, pain, fatigue, and

psychiatric disorders seen in this population.

Frederick Wolfe, MD, from the National Data Bank for Rheumatic Diseases

in Wichita, Kansas, told Medscape Medical News that his group will be presenting

similar data on fibromyalgia and suicide risk at the upcoming American College

of Rheumatology meeting. Medscape Medical News asked Dr. Wolfe to review the

Dreyer study.

" I believe Dreyer's suicide data are correct, but 10-fold

increase seems high, " Dr. Wolfe said.

He also emphasized that the suicide risk is increased but is very

small.

" Among depressed fibromyalgia patients in our study, there were very,

very few suicides. Clinicians should listen to the patient and decide if there

is a serious mood disorder, " Dr. Wolfe said.

A. Fishbain, MD, professor of psychiatry and adjunct professor

neurological surgery and anesthesiology at the University of Miami, Florida,

also reviewed the study for Medscape Medical News. Dr. Fishbain, who is an

expert on suicidality in patients with chronic pain, said that the Danish

results are consistent with a wide body of data from research on suicide in

patients with chronic pain. " Their data are one of the only studies on suicide

completion. These studies are very rare, " Dr. Fishbain said.

A wide body of pain literature has demonstrated that patients with

chronic pain (such as those with fibromyalgia) are at higher risk than nonpain

patients and the general population for suicide completion, attempts, and

ideation, he pointed out.

" Because chronic pain patients are at greater risk for all forms of

suicidality, every such patient should be evaluated carefully for suicide

ideation, " Dr. Fishbain said. He added that the American Psychiatric Association

now includes the presence of chronic pain as a suicide risk factor in its

guidelines on the evaluation and treatment of suicidality.

Jittender Sareen, MD, who also studies suicidal ideation and suicide

attempts in chronic pain conditions, told Medscape Medical News that the

increased suicide risk should be interpreted in context.

" It is important to note that although the [standardized mortality

ratio] was 10 times higher than normal, the vast majority of people with

fibromyalgia did not die by suicide. However, clinicians should screen for

depression and suicide, " Dr. Sareen said.

He added, " Overall, I think this is a well-constructed study. The major

strength is that they had clinician-diagnosed fibromyalgia. The major limitation

is that mental disorders were not adjusted for in the analysis. The major risk

factor for suicide is mental disorders, and fibromyalgia co-occurs with these

conditions. " Dr. Sareen is at the University of Manitoba,

Canada.