Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder

Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, MA, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 05/2008; 118(2):106-15. DOI: 10.1111/j.1600-0447.2008.01178.x
Source: PubMed


Relationships between antidepressant treatment and suicidality remain uncertain in major depressive disorder (MDD), and rarely evaluated in bipolar disorder (BPD).
We evaluated changes in suicidality ratings (Hamilton Depression Rating Scale item-3) at the start and after 3.59 +/- 2.57 months of sustained antidepressant treatment in a systematically assessed clinical sample (n = 789) of 605 patients with MDD, 103 patients with BPD-II and 81 patients with BPD-I (based on DSM-IV; 68.1% women; aged 44.3 +/- 16.1 years), comparing suicidal vs. non-suicidal and recovered vs. unrecovered initially suicidal patients.
Suicidal patients (103/789, 16.5%; BPD/MDD risk: 2.2) were more depressed and were ill longer. During treatment, 81.5% of suicidal patients became non-suicidal; 0.46% of 656 initially non-suicidal patients reported new suicidal thoughts, with no new attempts. Becoming non-suicidal was associated with greater depression severity and greater improvement.
Suicidal ideation was prevalent in patients with depressed major affective disorder, but most of the initially suicidal patients became non-suicidal with antidepressant treatment, independent of diagnosis, treatment type or dose.

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    • "Few studies have investigated the persistence of suicide risk in depressed patients with baseline suicidal ideation, and extant studies have reported inconsistent results, depending on research methods and sample characteristics. A naturalistic study of patients with unipolar or bipolar depression found that only 18.5% of 103 patients with baseline suicidal ideation remained suicidal after a mean of 3.5 months of antidepressant treatment (Tondo et al., 2008). This study found that more severe depression at baseline, and greater improvement during treatment, were independently associated with the remission of initial suicidality. "
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    ABSTRACT: The appropriate length of time for patients who visit clinics with significant suicidal ideation to be closely monitored is a critical issue for clinicians. We evaluated the course of suicidal ideation and associated factors for persistent suicidality in patients who entered treatment for depression with significant suicidal ideation. A total of 565 patients who had both moderate to severe depression (Hamilton Depression Rating Scale (HAMD) score ≥14) and significant suicidal ideation (Beck Scale for Suicide Ideation (SSI-B) score ≥6) were recruited from 18 hospitals in South Korea. Participants were assessed using the SSI-B, HAMD, Hamilton Anxiety Rating Scale, and Clinical Global Impression Scale-severity during a 12-week naturalistic treatment with antidepressant intervention. Participants were classified into resolved suicidality or persistent suicidality groups according to whether their suicidal ideation improved to SSI-B scores <6 and were sustained for 12 weeks. During the 12-week treatment, 206 (36.4%) patients were classified in the resolved suicidality group. Persistent suicidality was associated with intervention with SSRIs, higher SSI-B baseline score, and no HAMD or HAMA remission. The proportions of participants who had persistent suicidal ideation even with HAMD remission or response were 0.25 and 0.34, respectively. This study was observational, and the treatment modality was naturalistic. A considerable number of patients had persistent suicidal ideation despite 12 weeks of antidepressant treatment. Close monitoring for suicidal ideation may be needed beyond the initial weeks of treatment and even after a response to antidepressants is observed.
    Journal of Affective Disorders 11/2013; 155(1). DOI:10.1016/j.jad.2013.11.002 · 3.38 Impact Factor
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    • "2) the appropriate acute and long-term treatment of patients with major depressive and bipolar disorders markedly reduces the suicide mortality even in this high-risk patient-population [5,76,77] and initially suicidal depressives become nonsuicidal with antidepressant treatment [5,78]; and "
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    ABSTRACT: Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.
    Annals of General Psychiatry 06/2013; 12(1):21. DOI:10.1186/1744-859X-12-21 · 1.40 Impact Factor
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    • "This analysis of recent course suggests a typology that is not captured by the bipolar I versus bipolar II division or the rapid cycling specifier. Indeed, the predictive validity of a diagnosis of bipolar I or bipolar II is relatively weak, with no differences in the total number of episodes or duration of specific episodes, and contradictory results on the proportion of time in mood episodes (Judd et al. 2003b ; Mantere et al. 2008 ; Tondo et al. 2008). The stability and prospective validity of the course specifier ' with rapid cycling ' is acceptable , but does not capture many aspects of clinical course that are relevant to prognosis and treatment response (Dunner, 1998 ; Bauer et al. 2008). "
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    ABSTRACT: Background: Individual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up. Method Latent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder. Results: The best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type. Conclusions: There is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.
    Psychological Medicine 07/2012; 43(4):1-11. DOI:10.1017/S0033291712001523 · 5.94 Impact Factor
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