4.7 Article

Predictors of change in suicidal ideation across treatment phases of major depressive disorder: analysis of the STAR*D data

Journal

NEUROPSYCHOPHARMACOLOGY
Volume 46, Issue 7, Pages 1293-1299

Publisher

SPRINGERNATURE
DOI: 10.1038/s41386-020-00953-9

Keywords

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Funding

  1. Canadian Institutes of Health Research (CIHR)
  2. National Institutes of Mental Health (NIMH)
  3. Brain Canada
  4. Temerty Family
  5. Grant Family
  6. Centre for Addiction and Mental Health (CAMH) Foundation
  7. Campbell Institute
  8. Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto
  9. Canadian Institutes of Health Research
  10. CAMH Foundation
  11. Patient-Centered Outcomes Research Institute (PCORI)
  12. US National Institute of Health (NIH)
  13. Eli Lilly (NIH)
  14. Pfizer (NIH)
  15. CIHR
  16. NIH
  17. Temerty Family through the CAMH Foundation
  18. Campbell Family Research Institute
  19. NSERC
  20. McLaughlin Centre Accelerator Grant
  21. University of Toronto Connaught award
  22. University of Toronto Mississauga Research and Scholarly Activity Fund
  23. CANSSI Postdoctoral Fellowship

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The study analyzed STAR*D trial data and found that factors such as history of suicide attempts, comorbid medical illness, and family history of drug abuse can impact changes in suicidal ideation. Treatment with bupropion and buspirone was associated with reduction in suicidal ideation. Improvement in suicidal ideation was correlated with improvement in overall depression symptoms.
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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