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Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data
The effects of common antidepressants on suicidal ideation (SI) is unclear. In the landmark STAR*D trial antidepressants were effective for Major Depressive Disorder (MDD) in early treatment phases, but less effective in later phases. The effects of antidepressants on SI across the entire sample of...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819691/ https://www.ncbi.nlm.nih.gov/pubmed/33479508 http://dx.doi.org/10.1038/s41386-020-00953-9 |
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author | Weissman, Cory R. Hadas, Itay Yu, Dengdeng Jones, Brett Kong, Dehan Mulsant, Benoit H. Blumberger, Daniel M. Daskalakis, Zafiris J. |
author_facet | Weissman, Cory R. Hadas, Itay Yu, Dengdeng Jones, Brett Kong, Dehan Mulsant, Benoit H. Blumberger, Daniel M. Daskalakis, Zafiris J. |
author_sort | Weissman, Cory R. |
collection | PubMed |
description | The effects of common antidepressants on suicidal ideation (SI) is unclear. In the landmark STAR*D trial antidepressants were effective for Major Depressive Disorder (MDD) in early treatment phases, but less effective in later phases. The effects of antidepressants on SI across the entire sample of the STAR*D trial has never been investigated. We performed a secondary analysis of the STAR*D data with the primary outcome of change in score on the suicide item (item three) of the Hamilton Rating Scale for Depression (HRSD(17)) across all four study levels. We used descriptive statistics and logistic regression analyses. Pearson correlation was used for change in SI versus change in depression (HRSD(16)). Reduction in mean (SD) SI was greater in levels one: 0.29 (±0.78) (p < 0.001) and two: 0.26 (±0.88) (p < 0.001) than in levels three: 0.16 (±0.92) (p = 0.005) and four: 0.18 (±0.93) (p = 0.094). A history of past suicide attempts (OR 1.72, p = 0.007), comorbid medical illness (OR 2.23, p = 0.005), and a family history of drug abuse (OR 1.69, p = 0.008) were correlated with worsening of SI across level one. Treatment with bupropion (OR 0.24, p < 0.001) or buspirone (OR 0.24, p = 0.001) were correlated with lowering of SI across level two. Improvement in SI was correlated with improvement in overall depression (HRSD(16)) at level one: r(3756) = 0.48; level two: r(1027) = 0.38; level three: r(249) = 0.31; and level four: r(75) = 0.42 (p < 0.001 for all levels). Improvement in SI is limited with pharmacotherapy in patients with treatment-resistant depression. Treatments with known anti-suicidal effects in MDD, such as ECT, should be considered in these patients. |
format | Online Article Text |
id | pubmed-7819691 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-78196912021-01-22 Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data Weissman, Cory R. Hadas, Itay Yu, Dengdeng Jones, Brett Kong, Dehan Mulsant, Benoit H. Blumberger, Daniel M. Daskalakis, Zafiris J. Neuropsychopharmacology Article The effects of common antidepressants on suicidal ideation (SI) is unclear. In the landmark STAR*D trial antidepressants were effective for Major Depressive Disorder (MDD) in early treatment phases, but less effective in later phases. The effects of antidepressants on SI across the entire sample of the STAR*D trial has never been investigated. We performed a secondary analysis of the STAR*D data with the primary outcome of change in score on the suicide item (item three) of the Hamilton Rating Scale for Depression (HRSD(17)) across all four study levels. We used descriptive statistics and logistic regression analyses. Pearson correlation was used for change in SI versus change in depression (HRSD(16)). Reduction in mean (SD) SI was greater in levels one: 0.29 (±0.78) (p < 0.001) and two: 0.26 (±0.88) (p < 0.001) than in levels three: 0.16 (±0.92) (p = 0.005) and four: 0.18 (±0.93) (p = 0.094). A history of past suicide attempts (OR 1.72, p = 0.007), comorbid medical illness (OR 2.23, p = 0.005), and a family history of drug abuse (OR 1.69, p = 0.008) were correlated with worsening of SI across level one. Treatment with bupropion (OR 0.24, p < 0.001) or buspirone (OR 0.24, p = 0.001) were correlated with lowering of SI across level two. Improvement in SI was correlated with improvement in overall depression (HRSD(16)) at level one: r(3756) = 0.48; level two: r(1027) = 0.38; level three: r(249) = 0.31; and level four: r(75) = 0.42 (p < 0.001 for all levels). Improvement in SI is limited with pharmacotherapy in patients with treatment-resistant depression. Treatments with known anti-suicidal effects in MDD, such as ECT, should be considered in these patients. Springer International Publishing 2021-01-21 2021-06 /pmc/articles/PMC7819691/ /pubmed/33479508 http://dx.doi.org/10.1038/s41386-020-00953-9 Text en © The Author(s), under exclusive licence to American College of Neuropsychopharmacology 2021 |
spellingShingle | Article Weissman, Cory R. Hadas, Itay Yu, Dengdeng Jones, Brett Kong, Dehan Mulsant, Benoit H. Blumberger, Daniel M. Daskalakis, Zafiris J. Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title | Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title_full | Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title_fullStr | Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title_full_unstemmed | Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title_short | Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data |
title_sort | predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the star*d data |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819691/ https://www.ncbi.nlm.nih.gov/pubmed/33479508 http://dx.doi.org/10.1038/s41386-020-00953-9 |
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