Abstract
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 (HRSD17) 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 (HRSD16). 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 (HRSD16) 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.
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Data and/or research tools used in the preparation of this manuscript were obtained from the National Institute of Mental Health (NIMH) Data Archive (NDA). NDA is a collaborative informatics system created by the National Institutes of Health to provide a national resource to support and accelerate research in mental health. Dataset identifier: 2148. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH or of the Submitters submitting original data to NDA.
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CRW—First and primary author for manuscript. Performed relevant literature search, and primary author responsible for planning of study, data analysis, synthesis, and drafting and finalizing manuscript. IH—Co-second author. Primary data organization support. Co-author essential for sorting data and planning analysis, as well as drafting and finalizing manuscript. DY—Co-second author. Primary statistical support. Co-author essential for extensive data analysis, synthesis and drafting and finalizing manuscript. BJ—Co-author essential for data procurement and assisted in data analysis, synthesis and drafting and finalizing manuscript. DK—Supervisor and mentor of author DY. Co-author essential for data analysis, synthesis and drafting and finalizing manuscript. BHM—Co-author assisted in data analysis, synthesis and drafting and finalizing manuscript. DMB—Co-author assisted in data analysis, synthesis and drafting and finalizing manuscript. ZJD—Corresponding and senior author. Assisted in data analysis, synthesis and drafting and finalizing manuscript. Also instrumental in designing the study.
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Weissman, C.R., Hadas, I., Yu, D. et al. Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data. Neuropsychopharmacol. 46, 1293–1299 (2021). https://doi.org/10.1038/s41386-020-00953-9
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DOI: https://doi.org/10.1038/s41386-020-00953-9
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