Format

Send to

Choose Destination
J Clin Psychiatry. 2019 Jul 16;80(4). pii: 18m12575. doi: 10.4088/JCP.18m12575.

Trajectories of Suicidal Ideation During 12 Weeks of Escitalopram or Nortriptyline Antidepressant Treatment Among 811 Patients With Major Depressive Disorder.

Author information

1
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
2
iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
3
Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
4
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
5
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
6
Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
7
Department of Psychiatry, University of Bonn, Bonn, Germany.
8
Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznań University of Medical Sciences, Poznań, Poland.
9
University Psychiatric Clinic, Ljubljana, Slovenia.
10
Croatian Institute for Brain Research, Medical School, University of Zagreb, Zagreb, Croatia.
11
Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, Brussels, Belgium.
12
Psy Pluriel-Centre Européen de Psychologie Médicale, Brussels, Belgium.
13
Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
14
Departments of Psychiatry and Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.
15
Aarhus University Hospital-Psychiatry, Psychosis Research Unit, Aarhus, Denmark.
16
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
17
Psychosis Research Unit; Aarhus University Hospital-Psychiatry; Palle Juul-Jensen Blvd 175; DK-8200 Aarhus N, Denmark. karkoe@rm.dk.

Abstract

BACKGROUND:

Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation.

METHODS:

Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors.

RESULTS:

We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response.

CONCLUSION:

Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.

TRIAL REGISTRATION:

ISRCTN​​ identifier: ISRCTN03693000​​​​.

PMID:
31318184
DOI:
10.4088/JCP.18m12575

Supplemental Content

Full text links

Icon for Physicians Postgraduate Press, Inc.
Loading ...
Support Center