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Hedna K, Jonson M, Sigström R, Levinsson A, Nordenskjöld A, Waern M. Suicidal behavior and all-cause mortality in depressed older adults aged 75+ treated with electroconvulsive therapy: A Swedish register-based comparison study. Int J Geriatr Psychiatry 2024; 39:e6102. [PMID: 38767969 DOI: 10.1002/gps.6102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is effective in treating late-life depression. There is limited research on suicidal behavior and all-cause mortality in the oldest old after ECT. METHODS Older adults aged 75 years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non-fatal) and all-cause mortality in those who had received ECT and those with other depression treatments. RESULTS Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3 months: odds ratio 0.73; 95% confidence intervals (CI), 0.44-1.23, within 4 months to 1 year: aOR 1.34; 95% CI, 0.84-2.13). All-cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3 months (aOR, 0.35; 95% CI, 0.23-0.52), and within 4 months to 1 year (aOR 0.65; 95% CI, 0.50-0.83). CONCLUSIONS Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all-cause mortality in this age group, but we advise caution regarding causal inferences.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna Väst AB, Gothenburg, Sweden
| | - Mattias Jonson
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Sigström
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cognition and Old Age Psychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Levinsson
- Department of Social Medicine and Public Health, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal-CRCHUM, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Le Droguene E, Bulteau S, Deschamps T, Thomas-Ollivier V, Brichant-Petitjean C, Guitteny M, Laurin A, Sauvaget A. Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients: A Case Series. J ECT 2023; 39:255-262. [PMID: 37310091 DOI: 10.1097/yct.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. METHODS Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3-6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. RESULTS Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, -27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t1 (ie, after 3-4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t2 (ie, after 5-6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. CONCLUSIONS Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.
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Affiliation(s)
| | - Samuel Bulteau
- Nantes Université, CHU Nantes, INSERM, Methods in Patients-Centered Outcomes and Health Research
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | | | | | - Marie Guitteny
- CHU de Nantes, Service d'Addictologie et Psychiatrie de Liaison, Nantes, France
| | - Andrew Laurin
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement-Interactions-Performance, Nantes
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Youssef NA, George MS, McCall WV, Sahlem GL, Short B, Kerns S, Manett AJ, Fox JB, Dancy M, Cook D, Devries W, Rosenquist PB, Sackeim HA. The Effects of Focal Electrically Administered Seizure Therapy Compared With Ultrabrief Pulse Right Unilateral Electroconvulsive Therapy on Suicidal Ideation: A 2-Site Clinical Trial. J ECT 2021; 37:256-262. [PMID: 34015791 PMCID: PMC8606010 DOI: 10.1097/yct.0000000000000776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preliminary data suggest that focal electrically administered seizure therapy (FEAST) has antidepressant effects and less adverse cognitive effects than traditional forms of electroconvulsive therapy (ECT). This study compared the impact of FEAST and ultrabrief pulse, right unilateral (UB-RUL) ECT on suicidal ideation. METHODS At 2 sites, patients in a major depressive episode were treated openly with FEAST or UB-RUL ECT, depending on their preference. The primary outcome measure was scores on the Beck Scale for Suicide Ideation (SSI). Scores on the suicide item of the Hamilton Rating Scale for Depression (HRSD-SI) provided a secondary outcome measure. RESULTS Thirty-nine patients were included in the intent-to-treat sample (FEAST, n = 20; UB-RUL ECT, n = 19). Scores on both the SSI and HRSD-SI were equivalently reduced with both interventions. Both responders and nonresponders to the interventions showed substantial reductions in SSI and HRSD-SI scores, although the magnitude of improvement was greater among treatment responders. CONCLUSIONS Although limited by the open-label, nonrandomized design, FEAST showed comparable effects on suicidal ideation when compared with routine use of UB-RUL ECT. These results are encouraging and support the need for further research and a noninferiority trial.
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Affiliation(s)
| | | | - William V McCall
- From the Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Gregory L Sahlem
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Baron Short
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Suzanne Kerns
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Andrew J Manett
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | | | - Morgan Dancy
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Daniel Cook
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - William Devries
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Peter B Rosenquist
- From the Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Harold A Sackeim
- Departments of Psychiatry and Radiology, Columbia University, NY, NY
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Kucuker MU, Almorsy AG, Sonmez AI, Ligezka AN, Doruk Camsari D, Lewis CP, Croarkin PE. A Systematic Review of Neuromodulation Treatment Effects on Suicidality. Front Hum Neurosci 2021; 15:660926. [PMID: 34248523 PMCID: PMC8267816 DOI: 10.3389/fnhum.2021.660926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality. Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality. Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality. Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599, identifier: CRD42019125599.
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Affiliation(s)
- Mehmet Utku Kucuker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ammar G. Almorsy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ayse Irem Sonmez
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Anna N. Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Charles P. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Chen Y, Magnin C, Brunelin J, Leaune E, Fang Y, Poulet E. Can seizure therapies and noninvasive brain stimulations prevent suicidality? A systematic review. Brain Behav 2021; 11:e02144. [PMID: 33838000 PMCID: PMC8119823 DOI: 10.1002/brb3.2144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/13/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and incidence of suicidality remains unclear. Here, we aimed to provide an update on the effects of seizure therapies and noninvasive brain stimulation on suicidality. METHODS We conducted a systematic review of the literature in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Elsevier ScienceDirect, and Wiley Online Library databases using the MeSH terms "Electroconvulsive Therapy", "Magnetic Seizure Stimulation", "repetitive Transcranial Magnetic Stimulation", "transcranial Direct Current Stimulation", "Cranial Electrostimulation" and "suicide". We included studies using seizure therapies and noninvasive brain stimulation as a main intervention that evaluated suicidality, regardless of diagnosis. RESULTS Among 1,019 records screened, 26 studies met the inclusion criteria using either electroconvulsive therapy (n = 14), magnetic seizure therapy (n = 2), repetitive transcranial magnetic stimulation (n = 9), or transcranial direct current stimulation (n = 1). We observed that studies reported significant results, suggesting these techniques can be effective on the suicidal dimension of mental health pathologies, but a general statement regarding their efficacy is premature due to limitations. CONCLUSIONS Future enquiry is necessary to address methodological limitations and evaluate the long-term efficacy of these methods both alone and in combination with pharmacotherapy and/or psychotherapy.
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Affiliation(s)
- Yiming Chen
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Charline Magnin
- Department of Emergency PsychiatryEdouard Herriot HospitalHospices Civils de LyonLyonFrance
| | - Jérome Brunelin
- INSERM U1028, CNRS UMR5292Lyon Neuroscience Research Center, PSYR2 TeamUniversity of Lyon, CH Le VinatierLyonFrance
| | - Edouard Leaune
- INSERM U1028, CNRS UMR5292Lyon Neuroscience Research Center, PSYR2 TeamUniversity of Lyon, CH Le VinatierLyonFrance
| | - Yiru Fang
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina
- CAS Center for Excellence in Brain Science and Intelligence TechnologyShanghaiChina
- Shanghai Key Laboratory of Psychotic disordersShanghaiChina
| | - Emmanuel Poulet
- Department of Emergency PsychiatryEdouard Herriot HospitalHospices Civils de LyonLyonFrance
- INSERM U1028, CNRS UMR5292Lyon Neuroscience Research Center, PSYR2 TeamUniversity of Lyon, CH Le VinatierLyonFrance
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Park MJ, Kim H, Kim EJ, Yook V, Chung IW, Lee SM, Jeon HJ. Recent Updates on Electro-Convulsive Therapy in Patients with Depression. Psychiatry Investig 2021; 18:1-10. [PMID: 33321557 PMCID: PMC7897863 DOI: 10.30773/pi.2020.0350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics. METHODS We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995-2020. RESULTS Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported. CONCLUSION ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.
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Affiliation(s)
- Mi Jin Park
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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Abstract
OBJECTIVE Resolution of suicidal ideation for patients with major depressive disorder is an important public health challenge. We aimed to determine whether electroconvulsive therapy (ECT) or fluoxetine was more efficacious in resolving suicidal ideation and achieving long-term protective effect against suicidality. METHODS The data used in this study were drawn from 2 open-label trials for major depressive disorder patients receiving ECT or fluoxetine for acute treatment, together with continuation medication in the 12-week follow-up. We compared the effects of ECT and fluoxetine on suicidal ideation as scored by the suicide item on the 17-item Hamilton Rating Scale for Depression. RESULTS The differences between these 2 groups in time to resolution of suicidal ideation (suicide item = 0) in the acute treatment period, and time to relapse of suicidal ideation (suicide item score ≥1 or rehospitalization for suicidality) in the follow-up period were analyzed. Electroconvulsive therapy-treated patients (n = 111) had significantly shorter time to resolution of suicidal ideation than fluoxetine-treated patients (n = 114) during acute treatment. However, there was no statistically significant difference in time to relapse of suicidal ideation between 2 groups in the 12-week follow-up period. CONCLUSIONS Electroconvulsive therapy was superior to fluoxetine in resolving suicidal ideation during acute treatment. Therefore, ECT should be an early consideration for suicidal patients. Electroconvulsive therapy and fluoxetine were equally effective in preventing recurrence of suicidal ideation in the 12-week follow-up period. Routine suicide risk assessments from hospital care to outpatient care are required to identify any signs of suicidal relapse.
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Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective and a safe treatment for several severe psychiatric disorders across the age span. However, its use remains controversial and highly stigmatized especially among patients under 18 years. In this study, we examined current symptoms, attitudes, perception, and functioning of patients treated with ECT when they were less than 18 years old. METHODS Participants had received ECT before age 18, between 1989 and 2015, at a tertiary medical center. Institutional review board-approval was obtained, and study documents (cover letter, consent, self-ratings scales for depression, anxiety, global functioning, and suicidality) were mailed. RESULTS Based on self-rated depression, 59.1% (13/22) participants indicated mild or no depression; 65% (13/20) reported mild or no anxiety; the majority, 84.3% (16/19) perceived ECT as having improved their overall illness; and 27.3% (6/22) among the respondents reported no clinical impairment on a global functioning scale, whereas 72.7% (16/22) reported significant or severe impairment. Despite reports of ongoing impaired global functioning among some participants, adequate academic performance (83.3%, 5/6) and mild or no suicidality (78.3%, 18/23) were endorsed by the majority reported. CONCLUSIONS The majority of participants who had received ECT before age 18 years reported mild or absence of depression and anxiety on self-rated follow-up measures after treatment with ECT. Most notably, the majority reported absence of suicidality and adequate academic performance. A number of respondents, however, continued to endorse global impairment, which may be a reflection of their baseline severe illness, which had warranted treatment with ECT.
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Saunders KE, Smith KA. Interventions to prevent self-harm: what does the evidence say? EVIDENCE-BASED MENTAL HEALTH 2016; 19:69-72. [PMID: 27436413 PMCID: PMC10699448 DOI: 10.1136/eb-2016-102420] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 11/03/2022]
Abstract
Self-harm is a major public health concern and a risk factor for future suicide. It predominantly occurs in young people with around 65% of self-harm occurring before the age of 35. Self-harm causes distress to families and is associated with poorer educational outcomes as well as increased health and social care costs. Repetition is common with a quarter of individuals presenting to hospital with a further episode of self-harm within a year. We review the evidence from randomised controlled trials of treatments for self-harm, focusing on pharmacological and psychological approaches. We then contrast this with the current observational evidence and reflect on the challenges and limitations of randomised controlled trials for the treatment of self-harm.
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Affiliation(s)
- Kate E Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK;
| | - Katharine A Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK;
- NIHR Oxford Cognitive Health Clinical Research Facility, Warneford Hospital, Oxford, UK
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Kellner CH, Li EH, Farber KG, Geduldig ET, Ahle GM. Electroconvulsive Therapy (ECT) and Suicide Prevention. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0067-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Taneichi H, Asakura M, Sairenchi T, Haruyama Y, Wada K, Muto T. Low self-efficacy is a risk factor for depression among male Japanese workers: a cohort study. INDUSTRIAL HEALTH 2013; 51:452-458. [PMID: 23685852 DOI: 10.2486/indhealth.2013-0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The identification of risk factors for depression is necessary for the primary prevention of depression. The aim of this study is to determine whether self-efficacy (SE) is associated with onset of depression among workers. Medical expenditure records of 1,803 workers, who were clerks, system engineers, researchers, and service and sales workers in a software development company, were analyzed. Gender, age, job post, marital status, working hours, and SE were measured at baseline. Participants were divided according to quartiles of SE points. Risk ratios for undergoing a medical consultation due to depression were calculated using a multivariable Cox proportional hazards model. Of the 1,803 participants, 58 underwent medical consultation due to depression during a mean of 1.8 years of follow-up. Compared with the lowest quartile (Q1) of SE, adjusted hazard ratios (HR) were 0.65 (95%CI 0.34-1.25) for Q2, 0.49 (0.24-1.00) for Q3, and 0.40 (0.18-0.88) for Q4. In men, adjusted HRs were 0.87 (0.41-1.86) for Q2, 0.61 (0.26-1.41) for Q3, and 0.37 (0.14-0.98) for Q4. In women, no significant association was found. The present study suggests that low SE is a risk factor for onset of depression among male Japanese workers.
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Affiliation(s)
- Hiromi Taneichi
- Department of Public Health, Dokkyo Medical University School of Medicine, Japan
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Brain stimulation therapies for neuropsychiatric disease. NEUROBIOLOGY OF PSYCHIATRIC DISORDERS 2012; 106:681-95. [DOI: 10.1016/b978-0-444-52002-9.00041-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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13
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Hunt IM, Windfuhr K, Swinson N, Shaw J, Appleby L, Kapur N. Electroconvulsive therapy and suicide among the mentally ill in England: a national clinical survey. Psychiatry Res 2011; 187:145-9. [PMID: 21208662 DOI: 10.1016/j.psychres.2010.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 11/29/2010] [Accepted: 12/04/2010] [Indexed: 11/15/2022]
Abstract
We aimed to determine the number and characteristics of psychiatric patients receiving electroconvulsive therapy (ECT) who had subsequently died by suicide. Data were collected on an 8-year (1999-2006) sample of suicide cases in England who had been in recent contact with mental health services. Of 9752 suicides, 71 (1%) were being treated with ECT at the time of death. Although the number of patients who received ECT had fallen substantially over time, the rate of suicide in these individuals showed no clear decrease and averaged 9 deaths per year, or a rate of 10.8 per 10,000 patients treated. These suicide cases were typically older, with high rates of affective disorder and previous self-harm. They were more likely to be an in-patient at the time of death than other suicide cases. Nearly half of the community cases who had received ECT had died within 3 months of discharge. Our results demonstrated that the fall in the use of ECT has not affected suicide rates in patients receiving this treatment. Services appear to acknowledge the high risk of suicide in those receiving ECT. Improvements in care of these severely ill patients may include careful discharge planning and improved observation of in-patients in receipt of ECT.
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Affiliation(s)
- Isabelle M Hunt
- School of Community-Based Medicine, University of Manchester, Manchester, UK.
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Abstract
AbstractThe potential role of psychopharmacology in suicide prevention is often minimised. This may to some extent reflect that few medication trials have specifically focussed on prevention of suicidal behaviour – indeed this outcome is often not reported in trials. However, there is reasonably strong evidence that lithium may reduce risk of suicide, the postulated mechanism being a specific effect on aggression. Evidence is lacking with regard to any protective effect of other mood stabilizers. Clozapine may reduce suicidal behaviour in patients with schizophrenia, with reduction of affective symptoms being a possible explanation. The role of antidepressants in relation to suicide risk is highly controversial, especially in children and adolescents. It is unclear whether minor tranquillizers or hypnotics can assist in suicide prevention, although they can reduce the anxiety symptoms that may occur during initial treatment with SSRI antidepressants. Itis also uncertain whether psychopharmacology has a role in preventing suicidal behaviour in people with personality disorders. Despite the limitations of the evidence we contend that suicide risk should be an important factor in deciding when and what to prescribe.Declaration of Interest: We have no interests to declare.
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Abstract
SUMMARYAim – To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.Declaration of Interest: Neither author has any financial conflicts of interest in relation to this paper.
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Brådvik L, Berglund M. Repetition of suicide attempts across episodes of severe depression. Behavioural sensitisation found in suicide group but not in controls. BMC Psychiatry 2011; 11:5. [PMID: 21214896 PMCID: PMC3023739 DOI: 10.1186/1471-244x-11-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/07/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression. METHOD A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls. RESULTS The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls. CONCLUSION Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.
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Affiliation(s)
- Louise Brådvik
- Department of Clinical Sciences Lund, Division of Psychiatry, Lund University Hospital, Lund, Sweden.
| | - Mats Berglund
- Department of Clinical Alcohol Research, University Hospital MAS, Malmö, Lund University, Sweden
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Antidepressant therapy in severe depression may have different effects on ego-dystonic and ego-syntonic suicidal ideation. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:896395. [PMID: 21738871 PMCID: PMC3123969 DOI: 10.1155/2011/896395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/13/2011] [Indexed: 11/18/2022]
Abstract
The objective of the present study was to investigate whether ego-dystonic and ego-syntonic suicidal ideation occurred at different frequencies during antidepressant therapy. A blind evaluation has been performed on records of 100 suicides with a primary severe depression and 100 matched controls, admitted to the Department of Psychiatry, Lund, Sweden. Ego-dystonic suicidal ideation was more commonly reported during adequate treatment as compared to ego-syntonic ideation (P = .004). Men who committed suicide during adequate antidepressant therapy more often reported ego-dystonic suicidal ideation earlier in their lives compared with those who were not treated (P = .0377). This may indicate that treatment failure for ego-dystonic ideation was a precursor of their suicides. Consequently, ego-dystonic ideation seems to show a poorer response to antidepressant therapy as compared to ego-syntonic ideation, which may be more directly related to depression. Ego-dystonic ideation is proposed to be related to depressive psychosis.
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Abstract
Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions--especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be.
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Affiliation(s)
- Richard C Shelton
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Brådvik L, Berglund M. Depressive episodes with suicide attempts in severe depression: suicides and controls differ only in the later episodes of unipolar depression. Arch Suicide Res 2010; 14:363-7. [PMID: 21082451 DOI: 10.1080/13811118.2010.524068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to investigate the distribution of suicide attempts across the depressive episodes in suicides and controls with a severe depression. A blind record evaluation was performed of 100 suicide victims and matched controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. There was a similar number of episodes in suicides and controls and in the early episodes a similar number of suicide attempts in both groups. However, in the later episodes future suicides showed more suicide attempts as compared to controls. This was found for unipolar depression only. This difference was found despite previously shown similar rates of adequate treatment and improvement. In conclusion, more depressive episodes including suicide attempts appeared to be related to suicide.
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Affiliation(s)
- Louise Brådvik
- Department of Clinical Sciences Lund, Lund University Hospital, Sweden.
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Adequacy of, attitudes toward, and adherence to treatments by suicidal and nonsuicidal depressed patients. J Nerv Ment Dis 2008; 196:223-9. [PMID: 18340258 DOI: 10.1097/nmd.0b013e31816634f5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined differences in treatments received, and attitudes and adherence to them between suicidal and nonsuicidal patients with major depressive disorder (MDD). Psychiatric MDD patients with no suicidal behavior (N = 92), suicidal ideation (N = 92), or attempts (N = 34) were compared during 6 months of follow-up in the Vantaa Depression Study (VDS). Patients with suicidal behavior received antidepressants or adequate antidepressant treatment significantly more often, had more frequent appointments with psychiatrists, more psychotherapeutic support, and more favorable attitudes toward antidepressant treatment than nonsuicidal patients. However, after adjusting for the confounding severity of depression, the significance of these differences was lost. Adherence to treatment was similar in the patient groups. Overall, among psychiatric patients with MDD, those known to be suicidal have higher suicide risk and should receive more intensive treatment. However, suicidal behavior per se does not seem to markedly influence treatments provided nor should it be associated with negative attitudes or poor adherence to treatments.
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