Fibromyalgia comes with a suicide risk: study

Fibromyalgia comes with a suicide risk: study

By Genevra Pittman

NEW YORK (Reuters Health) - When treating women with fibromyalgia, doctors need to watch for depression and warning signs of suicide, a new study from Denmark shows.

Dr. Lene Dreyer, a rheumatologist at Copenhagen University Hospital, and colleagues compared hospital records and entries in the Danish Mortality Register for about 1350 patients with fibromyalgia, about 1270 of them women.

For the small group of men in the study, the authors found no difference in the overall death rate, or the death rates from specific conditions, at a mean follow-up of four years after referral to the hospital.

Women also died at a rate that would be expected among similar healthy women - a total of 41 over the course of the study, according to the June 25 online report in Arthritis & Rheumatism.

But 8 of those deaths were from suicide, a significantly higher proportion than in the general population. Among all Danish women, 5 to 6 out of 100,000 commit suicide every year.

"People with fibromyalgia don't just have fibromyalgia," Dr. Lesley Arnold told Reuters Health. Dr. Arnold is a professor of psychiatry at the University of Cincinnati who studies fibromyalgia but was not involved with the current research.

Dr. Arnold said it's been known for a long time that fibromyalgia puts patients at a higher risk for other medical conditions - many of them psychiatric. Still, she said, the research sends a strong message.

"We need to evaluate all of our patients with chronic pain in general for the presence of coexisting psychiatric disorders, especially mood and anxiety disorders," she said. "And of course (we need) to ask about suicide."

Dr. Bente Danneskiold-Samsoe, a rheumatologist at Frederiksberg Hospital in Copenhagen and one of the study's authors, said that other psychiatric illnesses that often occur in tandem with fibromyalgia might not be the only explanation for the high suicide rates.

None of the patients in the study who committed suicide had a history of psychiatric illness before they were diagnosed with fibromyalgia.

The high suicide rate could still be linked to depression in these patients, or to anti-depressants that are known to carry risks of suicide, she told Reuters Health. But "many of these patients do not take anti-depressant medications because of the side effects, and because they do not feel depressed," she said. "My opinion is that it has something to do with their pain."

Pain may be a major reason for suicide in itself, the authors write. Higher suicide rates have also been found for people who are tired all the time, and many people with fibromyalgia complain of sleep problems and fatigue.

Women in the study also died of liver disease and strokes at a higher rate than the general population. It's unclear what caused the higher rates of liver disease, the authors write, but people with fibromyalgia are more likely to be overweight and may not get much exercise because of their muscle pain, putting them at a greater risk for heart problems.

The results show that doctors should be aware of risk factors for a range of conditions when examining their patients with fibromyalgia, the authors write.

Dr. Arnold agreed. "You really have to get that whole history in order to help guide you as to what (treatment) approach to take," she said.

SOURCE: http://link.reuters.com/rej57m

Arthritis Rheum 2010.



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