This article is more than 5 years old. Information may no longer be current.
Suicidal ideation can occur despite antidepressant use in major depression
Click Here to Manage Email Alerts
About one in five patients with major depressive disorder experienced high or fluctuating suicidal ideation despite receiving antidepressant treatment for 12 weeks, according to results published in Journal of Clinical Psychiatry.
“Suicidal thoughts...represent a frequent, dangerous and difficult-to-treat challenge in patients with major depressive disorder,” Ole Kohler-Forsberg, MD, from the psychosis research unit at Aarhus University Hospital, Denmark, and colleagues wrote. “Nevertheless, little is known regarding the development and persistence of suicidal thoughts among patients with MDD, including clinically relevant predictors for different trajectories of suicidal ideation and whether different treatment approaches may have better effects.”
Researchers reported the trajectories of suicidal ideation in 811 patients with MDD who were randomly allocated to either 12 weeks of escitalopram or nortriptyline antidepressant treatment.
Participants were monitored weekly using the Montgomery-Asberg Depression Rating Scale, the 17-item Hamilton Depression Rating Scale and the Beck Depression Inventory. The investigators applied item response theory to determine the best estimate of suicidal ideation from the suicide items on the three rating scales. They also examined associations with potential predictors.
Kohler-Forsberg and colleagues found five distinct trajectory classes of suicidal ideation:
- the persistent-low class (53.7%), which showed no suicidal ideation;
- the fast-response class (26.5%), which had a high baseline severity, but responded quickly within the first few weeks and remained at a low level;
- the persistent-high class (9.8%), which had constant, high suicidal ideation throughout the 12 weeks of antidepressant treatment;
- the fluctuating-class (5.2%), which responded within 2 weeks but experienced an increase from week 4 to 9; and
- the slow-response-relapse class (4.8%), which responded slowly during the first 8 weeks but experienced a later steep increase to a high level of suicidal ideation after 12 weeks.
The results also showed that prior suicide attempts and higher mood symptom severity were linked to worse suicidal ideation trajectories and that living with a partner was linked to lower risk for suicidal ideation.
“Future large-scale trials need to (1) explore whether suicidal ideation may persist for longer periods and (2) identify predictors enabling clinicians to early identify the patients at risk for persistent suicidal ideation,” the researchers wrote. “On the basis of those findings, trials should (3) investigate whether specific treatment approaches, both pharmacologic and nonpharmacologic, may help high-risk patients with depression and persistent suicidal ideation, thereby potentially reducing the rate of suicide attempts and, hence, suicides.” – by Savannah Demko
Disclosures: Kohler-Forsberg reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to Top
Jonathan B. Singer, PhD, LCSW
This study provides evidentiary support for weekly med checks after prescribing antidepressants, especially for people with past suicide attempts. It also is a reminder to providers to continue monitoring for suicide risk, even after it appears to be gone. The authors found that all but the persistently high group (~10%) reported no significant suicidal ideation after 3 weeks. But two of those groups (fluctuating and slow response-relapse) reported that serious suicidal ideation returned at 5 weeks and 11 weeks respectively.
Non-medical providers should read this study as an affirmation of the significant role that social supports play in reducing suicide risk. The authors found that family support was one of two factors that seemed to have an influence on suicide ideation trajectories among people taking SSRIs.
Click Here to Manage Email Alerts