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.
    Full-text · Article · Nov 2013 · Journal of Affective Disorders
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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.
    Full-text · Article · Jun 2013 · Annals of General Psychiatry
    • "Retrospective and prospective follow-up clinical studies show that suicidal behavior (completed suicide and suicide attempt) and suicidal ideation in patients with mood disorders occur almost exclusively during severe major depressive episode, less frequently in mixed affective episode and dysphoric mania, and very rarely during euphoric mania, hypomania and euthymia (Hawton et al., 2005; Pompili et al., 2009b; Rihmer, 2007; Sokero et al., 2006; Tondo et al., 2008; Valtonen et al., 2005) indicating that suicidal behavior in unipolar and bipolar major mood disorder patients is a state-and severity dependent phenomenon. However, since the majority of unipolar and bipolar depressed patients never complete (and up to 50% of them never attempt) suicide (Goodwin and Jamison, 2007; Rihmer, 2007; Sokero et al., 2006), risk factors, other than major mood disorder itself, such as special clinical characteristics as well as some personality, familial and psychosocial risk and protective factors , should also play a significant contributory role (Balazs et al., 2006; Hawton et al., 2005; Mann et al., 1999; Rihmer, 2007; Tondo et al., 2008). Premorbid affective temperament types have an important role in the clinical evolution of minor and major mood episodes including the direction of polarity (unipolar or bipolar) and the symptom-formation of acute mood episodes (Perugi et al., 2012). "
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    ABSTRACT: The aim of the study was to investigate the relationship between the individual pattern of affective temperaments, non-typical symptoms of depression as measured with the Gotland Scale for Male Depression (GSMD), hopelessness and suicidal behavior in major mood disorder patients.Methods Participants were 346 adult inpatients (151 men and 195 women) with major mood disorders consecutively admitted to the Department of Psychiatry of the Sant'Andrea University Hospital in Rome, Italy. All the patients were administered the TEMPS-A, the GSMD, and the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).ResultsA Two Step Cluster Analysis procedure, performed to reveal natural groupings within patients' response set, indicated that there were 2-groups: a cyclothymic-depressive-anxious group and a hyperthymic group. More than 81% of the patients with prevailing cyclothymic-depressive-anxious temperament had mild to severe suicidal risk on the MINI vs. only around 42% of the patients with prevailing hyperthymic temperament., Sixty-four percent of patients with prevailing cyclothymic-depressive-anxious temperament had BHS scores of 9 or higher versus only 13% of patients with prevailing hyperthymic temperament. Also, patients with prevailing cyclothymic-depressive-anxious temperament more likely had higher GSMD than patients with prevailing hyperthymic temperament.Discussion and conclusionsOur results indicate that affective temperament measure along with Gotland Scale for Male Depression could be useful tools in screening and identifying those affective disorder patients who are at higher risk of suicidal behavior.
    No preview · Article · Dec 2012 · European Psychiatry
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