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Ladner L, Shick T, Adhikari S, Marvin E, Weppner J, Kablinger A. Association Between Impulsivity, Self-Harm, Suicidal Ideation, and Suicide Attempts in Patients with Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 39150012 DOI: 10.1089/neu.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Affiliation(s)
- Liliana Ladner
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Tyler Shick
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Srijan Adhikari
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Eric Marvin
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Justin Weppner
- Department of Internal Medicine, Carilion Clinic, Roanoke, Virginia, USA
| | - Anita Kablinger
- Department of Psychiatry and Behavioral Medicine, Carilion Clinic, Roanoke, Virginia, USA
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2
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Isometsä E. Antidepressants and suicide-More benefit than harm. Eur Neuropsychopharmacol 2024; 83:9-10. [PMID: 38490017 DOI: 10.1016/j.euroneuro.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), FI-00014, Finland.
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Riera-Serra P, Navarra-Ventura G, Castro A, Gili M, Salazar-Cedillo A, Ricci-Cabello I, Roldán-Espínola L, Coronado-Simsic V, García-Toro M, Gómez-Juanes R, Roca M. Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01716-5. [PMID: 38015265 DOI: 10.1007/s00406-023-01716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
Patients with depressive disorders are especially prone to suicide risk. Among the clinical predictors of suicidality, those specifically related to depressive disorders have not been accurately detailed. Our aim was to conduct a systematic review and meta-analysis of studies reporting longitudinal predictors of suicidal ideation, suicide attempts and suicide death within depression, including diagnostic subtypes, symptoms, clinical course, and assessment scales. A systematic search of the literature between 2001 and 2022 identified 4422 references, among which 19 studies providing 45 different predictors of suicidality met the inclusion criteria. Random effects meta-analyses were performed for 22 predictors, three for suicidal ideation, eleven for suicide attempts and eight for suicide death. Heterogeneity and publication bias were inspected through I2 tests and Egger's tests respectively. Meta-analysis results showed that severity of hopelessness predicted suicidal ideation and suicide attempts. History of suicide attempts, suicidal ideation, severe depression, and psychotic symptoms predicted subsequent suicide attempts and suicide death. Time to full remission and sleep disturbances were also found as relevant predictors of future suicide behaviours. This review specifies which predictors of suicidality within the clinical features of depression will help clinicians and policy makers to better prevent suicide risk in patients with depressive disorders. Further longitudinal studies are needed to reliably assess the predictive ability of our results and to analyse other possible clinical predictors to prevent suicidality, especially with regard to suicidal ideation.
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Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Angie Salazar-Cedillo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Balearic Islands Health Services (IB-SALUT), Primary Care Research Unit of Mallorca, Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lorenzo Roldán-Espínola
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Mauro García-Toro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Rocío Gómez-Juanes
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
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4
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Persistent suicidal ideation in major depressive disorder patients: still in need of empathic understanding. Int Clin Psychopharmacol 2022; 37:279-280. [PMID: 36165512 DOI: 10.1097/yic.0000000000000434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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5
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Nobile B, Olié E, Dubois J, Benramdane M, Guillaume S, Courtet P. Characterization of suicidal depression: a one-year prospective study. Eur Psychiatry 2022; 65:1-40. [PMID: 35431010 PMCID: PMC9058444 DOI: 10.1192/j.eurpsy.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Suicidal ideation (SI) is an important risk factor of death by suicide. Recent data suggest that suicidal depression (i.e., moderate to severe depression with SI) could be a specific depression subtype with worse clinical outcomes than nonsuicidal depression (i.e., without SI). Methods Among 898 French adult inpatients (67% women, mean age: 41.23 [SD: 14.33]) with unipolar depression, 71.94% had moderate to severe depression (defined using the cut-offs of validated scales: beck depression inventory, clinician-rated 30-item inventory depression symptomatology, and quick inventory of depressive symptomatology) and among them, 63.6% had SI according to the suicidal item (score ≥ 2) of the depression scale they filled in. Clinical features (anxiety, psychological pain, and hopelessness) were assessed at baseline. The occurrence of a suicide attempt (SA) or a suicide event (SE) (i.e., actual, aborted or interrupted SA, or hospitalization for SI) was recorded during the 1-year follow-up. The risk of actual SA and SE was compared between groups with adjusted Cox regression models. Results The risk of actual SA and SE during the follow-up was 2- and 1.8-fold higher, respectively, in patients with suicidal depression, independently of potential cofounders such as history of lifetime SA, age, sex, and baseline depression severity. Conclusions Suicidal depression is associated with poorer prognosis in terms of actual SA/SE, despite optimal care (i.e., care in a hospital department specialized in the management of suicidal crisis). Specific therapeutic strategies might be needed for these patients.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Myriam Benramdane
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
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6
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Pisanu C, Severino G, De Toma I, Dierssen M, Fusar-Poli P, Gennarelli M, Lio P, Maffioletti E, Maron E, Mehta D, Minelli A, Potier MC, Serretti A, Stacey D, van Westrhenen R, Xicota L, Baune BT, Squassina A. Transcriptional biomarkers of response to pharmacological treatments in severe mental disorders: A systematic review. Eur Neuropsychopharmacol 2022; 55:112-157. [PMID: 35016057 DOI: 10.1016/j.euroneuro.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022]
Abstract
Variation in the expression level and activity of genes involved in drug disposition and action in tissues of pharmacological importance have been increasingly investigated in patients treated with psychotropic drugs. Findings are promising, but reliable predictive biomarkers of response have yet to be identified. Here we conducted a PRISMA-compliant systematic search of PubMed, Scopus and PsycInfo up to 12 September 2020 for studies investigating RNA expression levels in cells or biofluids from patients with major depressive disorder, schizophrenia or bipolar disorder characterized for response to psychotropic drugs (antidepressants, antipsychotics or mood stabilizers) or adverse effects. Among 5497 retrieved studies, 123 (63 on antidepressants, 33 on antipsychotics and 27 on mood stabilizers) met inclusion criteria. Studies were either focused on mRNAs (n = 96), microRNAs (n = 19) or long non-coding RNAs (n = 1), with only a minority investigating both mRNAs and microRNAs levels (n = 7). The most replicated results include genes playing a role in inflammation (antidepressants), neurotransmission (antidepressants and antipsychotics) or mitochondrial function (mood stabilizers). Compared to those investigating response to antidepressants, studies focused on antipsychotics or mood stabilizers more often showed lower sample size and lacked replication. Strengths and limitations of available studies are presented and discussed in light of the specific designs, methodology and clinical characterization of included patients for transcriptomic compared to DNA-based studies. Finally, future directions of transcriptomics of psychopharmacological interventions in psychiatric disorders are discussed.
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Affiliation(s)
- Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Giovanni Severino
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Ilario De Toma
- Center for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Mara Dierssen
- Center for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Intervention and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Pietro Lio
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Elisabetta Maffioletti
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Eduard Maron
- Department of Psychiatry, University of Tartu, Tartu, Estonia; Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Divya Mehta
- Queensland University of Technology, Centre for Genomics and Personalised Health, Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - David Stacey
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute, Amsterdam, The Netherlands; Department of Psychiatry and Neuropsychology, Faculty of Health and Sciences, Maastricht University, Maastricht, The Netherlands; Institute of Psychiatry, Psychology&Neuroscience (IoPPN) King's College London, UK
| | - Laura Xicota
- Paris Brain Institute ICM, Salpetriere Hospital, Paris, France
| | | | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Germany; Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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7
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Li K, Zhou G, Xiao Y, Gu J, Chen Q, Xie S, Wu J. Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies. Front Psychiatry 2022; 13:880496. [PMID: 35693956 PMCID: PMC9178080 DOI: 10.3389/fpsyt.2022.880496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although several studies have reviewed the suicidal risk of antidepressants, the conclusions remain inconsistent. We, therefore, performed a meta-analysis of observational studies to address the association between exposure to antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and the risk of suicide and suicide attempt in children and adolescents. METHODS MEDLINE and Embase were searched from January 1990 to April 2021. Seventeen cohort and case-control studies were identified that reported suicide or suicide attempt in children and young adults (aged 5-25 years) who were exposed to any antidepressants. We extracted the estimates and corresponding 95% confidence intervals (CIs) from each publication. RESULTS The results showed that antidepressant exposure significantly increased the risk of suicide and suicide attempt when compared with no antidepressant usage among children and adolescents. The pooled relative risk (RR) was 1.38 (95% CI: 1.16-1.64; I 2 = 83.1%). Among the antidepressants, SSRI use was associated with an increased risk of suicide and suicide attempt, and the pooled RR was 1.28 (95% CI: 1.09-1.51; I 2 = 68.8%). In subgroup analysis, the attempted suicidal risk of antidepressant and SSRI was significantly increased (RR = 1.35, 95% CI: 1.13-1.61; I 2 = 86.2% for all antidepressants; and RR = 1.26, 95% CI: 1.06-1.48; I 2 = 73.8% for SSRIs), while the completed suicidal risk of antidepressant and SSRI was not statistically significant (RR = 2.32, 95% CI: 0.82-6.53; I 2 = 6.28% for all antidepressants; and RR = 1.88, 95% CI: 0.74-4.79; I 2 = 52.0% for SSRIs). In addition, the risk of suicide and suicide attempt between SSRIs and other antidepressants was similar (RR 1.13, 95% CI: 0.87-1.46, I 2 = 32.4%). CONCLUSION The main findings of this meta-analysis provide some evidence that antidepressant exposure seems to have an increased suicidal risk among children and young adults. Since untreated depression remains one of the largest risk factors for suicide and the efficacy of antidepressants is proven, clinicians should evaluate carefully their patients and be cautious with patients at risk to have treatment emergence or worsening of suicidal ideation (TESI/TWOSI) when prescribing antidepressants to children and young patients.
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Affiliation(s)
- Kuan Li
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Shenzhen Key Laboratory of Prevention and Treatment of Severe Infections, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Guibao Zhou
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yan Xiao
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Jiayu Gu
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Qiuling Chen
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Shouxia Xie
- Department of Pharmacy, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Junyan Wu
- Department of Pharmacy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Strumila R, Nobile B, Korsakova L, Lengvenyte A, Olie E, Lopez-Castroman J, Guillaume S, Courtet P. Psilocybin, a Naturally Occurring Indoleamine Compound, Could Be Useful to Prevent Suicidal Behaviors. Pharmaceuticals (Basel) 2021; 14:ph14121213. [PMID: 34959614 PMCID: PMC8704767 DOI: 10.3390/ph14121213] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
The available interventions for people who are at risk of suicide have limited efficacy. Recently, research on new mental health treatments has started to consider psychedelic compounds, particularly psilocybin, a molecule with a few thousand years of history of use in human societies. The possible effects of psilocybin on suicidal ideation and behaviors have not been specifically studied yet; however, the current knowledge on the suicidal process and the available data on es/ketamine suggest that psylocibin could be used to modulate the thoughts and behavioral patterns in individuals who are at risk of suicidal behaviors. Here, we summarize the available evidence on the possible mechanisms underlying psilocybin positive effects on suicide risk. Major pathways related to suicidal behaviors that might be modulated by psylocibin include serotonin receptors. Specifically, psylocibin directly stimulates the serotonin 2A receptor (5HT2A), targeting the inflammatory and oxidative stress pathways and leading to a rapid increase in brain plasticity and inflammation suppression and increases in cognitive flexibility, spirituality, and empathy. We also present preliminary epidemiological data and provide a rationale for studying psilocybin in individuals with suicidal ideation or who are at risk of suicidal behaviors. This review presents a framework to understand the basis for psilocybin use in individuals who are at risk of suicidal behaviors and calls for clinical studies.
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Affiliation(s)
- Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (R.S.); (B.N.)
| | - Bénédicte Nobile
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Correspondence: (R.S.); (B.N.)
| | - Laura Korsakova
- Laboratory of Preclinical Drug Investigation, Institute of Cardiology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Aiste Lengvenyte
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Emilie Olie
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Jorge Lopez-Castroman
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
- Department of Adult Psychiatry, Nimes University Hospital, 44307 Nimes, France
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28001 Madrid, Spain
| | - Sébastien Guillaume
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
| | - Philippe Courtet
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 34000 Montpellier, France; (A.L.); (E.O.); (S.G.); (P.C.)
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34295 Montpellier, France;
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9
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Hedna K, Montuori C, Forte A, Pompili M, Waern M. Use of antidepressants and risk of repeat self-harm in older adults 75+ with nonfatal self-harm: A 1-year prospective national study. Pharmacoepidemiol Drug Saf 2021; 31:206-213. [PMID: 34687250 DOI: 10.1002/pds.5375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess exposure to antidepressants (AD) before and after nonfatal self-harm (SH) in older adults and to examine 1-year rates and risk factors for subsequent SH. METHODS Longitudinal national register-based retrospective cohort study of Swedish residents aged 75+ (N = 2775) with treatment at hospital or specialist outpatient clinic in connection with SH between January 1, 2006, and December 31, 2013. The cohort was followed for 1 year after the index episode. Exposure to AD was assessed at index and at subsequent SH. Cox regression analysis was used to assess factors associated with 1-year repeat SH. RESULTS At the index episode, 51% were prevalent AD users; 23% started AD during the following year. Overall 12% of prevalent AD users, 8% of AD nonusers, and 6% of AD new users repeated SH or died by suicide. About two-thirds of these subsequent behaviors occurred within 3 months after the index episode. Men had increased risk of subsequent SH (Hazard ratio [HR] 1.38, 95% CI: 1.09-1.74); older age (>85 years) was associated with a lower risk (HR 0.72, CI 95% 0.55-0.93). Users of AD did not have an increased risk of repeat SH. CONCLUSIONS Half of older adults who self-harmed were prevalent AD users and a further one fourth started an AD within 1 year after the index SH. Antidepressant use was not associated with increased risk of subsequent SH in this high-risk cohort of older adults.
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Affiliation(s)
- Khedidja Hedna
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Statistikkonsulterna AB, Gothenburg, Sweden
| | - Chiara Montuori
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, AgeCap Center, Gothenburg University, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies. J Affect Disord 2021; 293:148-158. [PMID: 34192629 DOI: 10.1016/j.jad.2021.05.115] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicidal ideation (SI) and suicide planning (SP) are associated with an increased risk of future suicide. We performed a meta-analysis of observational studies to estimate the prevalence of SI and SP in patients with major depressive disorder (MDD) and its associated factors. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Web of Science from their commencement date until 7 October 2020. Original studies containing data on the prevalence of SI and SP in individuals with MDD were analyzed. RESULTS Forty-six articles covering 53,598 patients were included in the meta-analysis. The overall prevalence of SI was 37.7% (95% confidence interval (CI): 32.3-43.4%) and the pooled prevalence of SP was 15.1% (95% CI: 8.0--26.8%). Subgroup analyses revealed that the timeframe over which SI was assessed, source of patients, study design, and diagnostic criteria were significantly associated with the pooled prevalence of SI. Meta-regression analyses revealed that the Hamilton Depression Rating Scale (HAMD) score and percentage of male participants were positively associated with the pooled prevalence of SI. Study quality and mean age were negatively associated with the pooled prevalence of SI. In contrast, survey year and study quality were negatively associated with pooled prevalence of SP LIMITATION: SI and SP were self-reported and subject to recall bias and impression management. CONCLUSIONS SI and SP are common in patients with MDD, especially among inpatients. Preventive measures and treatments focusing on factors associated with SI and SP may reduce the risk of suicide in patients with MDD.
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Polymorphisms of stress pathway genes and emergence of suicidal ideation at antidepressant treatment onset. Transl Psychiatry 2020; 10:320. [PMID: 32952155 PMCID: PMC7502493 DOI: 10.1038/s41398-020-01003-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 01/17/2023] Open
Abstract
The prescription of antidepressant drugs is one of the most frequently used strategies to prevent suicide and suicidal behavior. However, some patients develop suicidal ideation at antidepressant treatment onset, a phenomenon known as treatment-emergent suicidal ideation (TESI). Few studies have explored TESI pharmacogenomics. As the Hypothalamic-Pituitary-Adrenal (HPA) axis might be implicated in suicidal behavior, we assessed the relationship between TESI and single nucleotide polymorphisms (SNPs) in the HPA axis-implicated NR3C1 (n = 7 SNPs), FKBP5 (n = 5 SNPs), AVPR1B (n = 1 SNPs), CRHR1 (n = 1 SNPs), and SKA2 (n = 1 SNPs) genes, in a sample of 3566 adult outpatients with depression for whom an antidepressant treatment was introduced. General practitioners and psychiatrists throughout France followed participants for 6 weeks after the initial prescription of tianeptine, an antidepressant molecule showing mu agonism. Suicidal ideation was assessed with item 10 of the Montgomery-Åsberg Depression Rating Scale (item dedicated to suicidal ideation) at baseline, and at week 2, 4, and 6 of treatment. Within the informative sample, 112 patients reported TESI and 384 did not. TESI was significantly associated with the TT genotype of the SNP rs6902321 in FKBP5 (OR = 1.76, 95% CI = [1.07; 2.90]; p-value = 0.03) and the GG/AG genotype of the SNP rs7208505 in SKA2 (OR = 1.85, 95% CI = [1.03;3.33]; p-value = 0.04). These associations were not significant after multiple test correction. Nevertheless, our results suggest a possible involvement of HPA axis elements in treatment-emergent suicidal ideation (TESI).
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Évaluation clinique de l’aggravation du risque suicidaire sous antidépresseurs. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2014.09.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
La dépression, deuxième source de handicap, constitue le principal facteur de risque de suicide. Il a été proposé à juste titre que le traitement de la dépression soit une stratégie efficace de prévention du suicide. Pourtant la dernière décennie a été marquée par les controverses sur le risque suicidaire potentiel des antidépresseurs, qui ont eu des effets néfastes sur la prise en charge des patients. Puisque les alertes sur ce risque ont été proposées à partir des résultats d’études qui n’avaient pas comme objectif de s’intéresser au processus suicidaire, nous avons réalisé une étude destinée à évaluer la survenue d’idées et de tentatives de suicide chez 4357 patients déprimés ambulatoires traités par antidépresseur et suivis 6 semaines en condition naturelles. Une idéation suicidaire est apparue de novo chez 9 % des patients qui n’en avaient pas à l’inclusion. Les critères prédictifs étaient l’aggravation de la symptomatologie anxieuse ou dépressive et l’instauration d’un nouveau traitement après échec antérieur. Deux pour cent des patients ont réalisé une TS au cours des 6 semaines de suivi. Les critères prédictifs étaient l’aggravation de la symptomatologie dépressive ou du désespoir, l’instauration d’un nouveau traitement après échec antérieur, et l’existence de mésusage d’alcool et d’antécédents de TS. Ces résultats suggèrent que le risque suicidaire en début de traitement soit lié aux facteurs de risque suicidaires, dont l’inefficacité du traitement antidépresseur. Par ailleurs, nous avons montré que l’initiation d’un traitement par non ISRS ou d’un traitement ISRS à forte dose augmente le risque d’aggravation des idées de suicide. L’ensemble de ces données, confortées par la littérature, nous indique que les médecins possèdent les outils de prévention en évaluant précisément et régulièrement la dépression et le risque suicidaire au cours du traitement antidépresseur.
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Lopez-Castroman J, Jaussent I, Gorwood P, Courtet P. Activation syndrome induced by the antidepressant tianeptine and suicidal ideation: Evidence from a large depressed outpatient sample. Prog Neuropsychopharmacol Biol Psychiatry 2020; 97:109762. [PMID: 31526830 DOI: 10.1016/j.pnpbp.2019.109762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the characteristics of the activation syndrome (AS) that predict the emergence or worsening of suicidal ideation (SI) in the first month of antidepressant treatment with tianeptine, as well as the temporal relationship between both conditions. METHOD A naturalistic sample of 2422 depressed outpatients starting a new antidepressant treatment with tianeptine was assessed at 2, 4 and 6 weeks of follow-up using validated questionnaires. Four main dimensions of AS were examined: impulsivity, sleep problems, anxiety and agitation. RESULTS The emergence of an AS was more likely in long-lasting depressive episodes, but less likely if the patient responded to the antidepressant or benzodiazepines were added as an add-on treatment. Treatment-emergent SI was strongly associated to the presence of an AS, particularly in case of sleep problems (OR = 8.42) or impulsivity upsurges (OR = 3.89), even after adjustment for all relevant confounding factors. CONCLUSIONS Our findings suggest a dose-effect mechanism modulating the relationship between treatment-related SI and AS. AS symptoms may need to be monitored closely in the weeks that follow the introduction of an antidepressant treatment.
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Affiliation(s)
- Jorge Lopez-Castroman
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France; Department of Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nîmes, France; CIBERSAM, Spain.
| | - Isabelle Jaussent
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France
| | - Philip Gorwood
- Sainte-Anne Hospital (CMME), INSERM U894, 1 Rue Cabanis, 75014 Paris, France
| | - Philippe Courtet
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France; Department of Emergency Psychiatry and Acute Care, Montpellier University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France
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14
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Dong M, Zeng LN, Lu L, Li XH, Ungvari GS, Ng CH, Chow IHI, Zhang L, Zhou Y, Xiang YT. Prevalence of suicide attempt in individuals with major depressive disorder: a meta-analysis of observational surveys. Psychol Med 2019; 49:1691-1704. [PMID: 30178722 DOI: 10.1017/s0033291718002301] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD. METHODS A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed. RESULTS In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27-34%], 1-year prevalence was 8% (95% CI 3-14%) and 1-month prevalence was 24% (95% CI 15-34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting. CONCLUSION This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Liang-Nan Zeng
- Department of Neurosurgery,The Affiliated Hospital of Southwest Medical University,Luzhou,China
| | - Li Lu
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University,Beijing,China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre,Perth,Australia
| | - Chee H Ng
- Department of Psychiatry,University of Melbourne,Melbourne, Victoria,Australia
| | - Ines H I Chow
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics,School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology,Beijing,China
| | - Yuan Zhou
- CAS Key Laboratory of Behavioral Science & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences,Beijing,China
| | - Yu-Tao Xiang
- Unit of Psychiatry,Faculty of Health Sciences,University of Macau,Macao SAR,China
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15
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Nobile B, Ramoz N, Jaussent I, Gorwood P, Olié E, Castroman JL, Guillaume S, Courtet P. Polymorphism A118G of opioid receptor mu 1 (OPRM1) is associated with emergence of suicidal ideation at antidepressant onset in a large naturalistic cohort of depressed outpatients. Sci Rep 2019; 9:2569. [PMID: 30796320 PMCID: PMC6385304 DOI: 10.1038/s41598-019-39622-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/18/2019] [Indexed: 12/18/2022] Open
Abstract
Antidepressants have been the object of an international controversy for about thirty years. Some patients are inclined to develop suicidal ideation (SI) at antidepressant onset; this phenomenon is known as Treatment Emergent Suicidal Ideation (TESI), and it has conducted regulatory bodies to prompt warnings on antidepressants. Since, few studies have explored the pharmacogenomics of TESI. Given the growing body of evidence connecting the opioidergic system with suicidal behavior (particularly mu opioid receptor (MOR)), we decided to examine the relationship between two genetic polymorphisms (SNPs) in the opioidergic system and TESI in a sample of 3566 adult depressed outpatients. General practitioners and psychiatrists throughout France followed participants for 6 weeks after an initial prescription of tianeptine, an antidepressant treatment with mu agonism. Suicidal ideation was assessed with the item 10 of the Montgomery-Asberg Depression Rating Scale (item dedicated to SI) at baseline, and after 2 weeks, 4 weeks and 6 weeks. We analysed rs1799971 from the OPRM1 gene and rs105660 from the OPRK1 gene. Within the sample, 112 patients reported TESI while 384 did not. We found a significant association between AA genotype of rs1799971 and TESI even after adjustment for potential cofounders (OR = 1.93, 95% CI = [1.07; 3.49]; p-value = 0.03). On the other hand there were no significant association between rs1799971 and rs105560 with worsening of suicidal ideation or lifetime suicide attempts. Nevertheless, our results suggest a possible involvement of opioidergic system in TESI.
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Affiliation(s)
- B Nobile
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France.
| | - N Ramoz
- INSERM UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Université Sorbonne Paris Cité, Paris, France
| | - I Jaussent
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France
| | - Ph Gorwood
- INSERM UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Université Sorbonne Paris Cité, Paris, France
| | - E Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - J Lopez Castroman
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France
- Department of Psychiatry, CHU Nimes, Nimes, France
| | - S Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Ph Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- INSERM, U1061, Neuropsychiatry, University Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
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Pompili M. Critical appraisal of major depression with suicidal ideation. Ann Gen Psychiatry 2019; 18:7. [PMID: 31164909 PMCID: PMC6543655 DOI: 10.1186/s12991-019-0232-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Regardless of its nature, suicidal ideation, in the absence of another diagnosis, is quintessentially associated with major clinical depression. Although for the characteristics of being depressed it is reasonable to have some wish to die, there is no real attempt to understanding the suicidal mind. Clinicians are therefore often inclined to consider suicidal ideation a symptom of major depression. Yet, most depressed patients do not die by suicide, and many of them never experience suicidal ideation even in the most severe depressing scenario. At a closer look, when one works with suicidal individual, suicide appears complex and not line with the obsolete medical model. There are often warning signs for suicide, and suicidal individuals experience mental pain as a common denominator of many adverse events. CASE PRESENTATION A case report of an entrepreneur with no previous psychiatric history describes the process of meditating suicide as a dimension overlapping the depressive disorder. Details of how this 63-year-old male developed high suicide risk are reported, and clinicians are guided into the understanding of suicide risk. CONCLUSIONS Nowadays, clinicians are requested to provide an in-depth investigation into the suicidal mind, an assessment adjunctive to the psychiatric evaluation. A phenomenological approach may be the key to unlock the suicidal mind. Clinicians may use such tool in light of the need for the empathic understanding of human suffering as well as a paradigm shift in the care of suicidal individuals.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Chakravorty S, Smith RV, Perlis ML, Grandner MA, Kranzler HR. Circadian Pattern of Deaths Due to Suicide in Intoxicated Alcohol-Dependent Individuals. J Clin Psychiatry 2018; 79. [PMID: 30358241 PMCID: PMC7486887 DOI: 10.4088/jcp.17m11800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 04/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Alcohol intoxication and dependence are risk factors for suicide, a leading cause of death in the United States. We examined the hours of peak and nadir in completed suicides over a 24-hour period among intoxicated, alcohol-dependent individuals. We also evaluated suicide-related factors associated with intoxication at different times of the day. METHODS We analyzed cross-sectional data from the 2003-2010 National Violent Death Reporting System provided by 16 US states. In the primary database, the deceased individuals' alcohol-dependent status was classified as "yes" or "no or unknown." We restricted the analysis to alcohol-dependent individuals with alcohol level data available (N = 3,661). The primary outcome measure was the reported time of death. Secondary outcome measures were predisposing and injury-related factors. Individuals were classified on the basis of their blood alcohol level (BAL) as heavy drinking (BALH [≥ 80 mg/dL]) or non-heavy drinking (BALO [< 80 mg/dL]). The time of injury was divided into 1-hour bins, which were used to compute the incidence of suicide over 24 hours. We also evaluated the association between clinical factors and BALH for each of six 4-hour time periods beginning at 00:01 hours. RESULTS The majority (73.4%) of individuals showed evidence of alcohol consumption prior to committing suicide. BALH was observed in 60.7% of all individuals. Peak incidences in suicide were identified at 21:00 for BALH and 12:00 for BALO, with nadirs at 05:00 and 03:00 hours, respectively. In a multivariable analysis, between 20:01 and 00:00 hours, BALH was associated with more risk and protective factors than BALO. CONCLUSIONS Identifying critical times and associated risk factors for suicidal behavior may contribute to suicide prevention efforts in intoxicated alcohol-dependent individuals.
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Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Perelman School of Medicine, MIRECC, 2nd Fl, Postal Code 116, 3900 Woodland Ave, Philadelphia, PA 19104. .,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel V Smith
- University of Louisville School of Nursing, Louisville, Kentucky, USA
| | - Michael L Perlis
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Henry R Kranzler
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Consoloni JL, Ibrahim EC, Lefebvre MN, Zendjidjian X, Olié E, Mazzola-Pomietto P, Desmidt T, Samalin L, Llorca PM, Abbar M, Lopez-Castroman J, Haffen E, Baumstarck K, Naudin J, Azorin JM, El-Hage W, Courtet P, Belzeaux R. Serotonin transporter gene expression predicts the worsening of suicidal ideation and suicide attempts along a long-term follow-up of a Major Depressive Episode. Eur Neuropsychopharmacol 2018; 28:401-414. [PMID: 29287766 DOI: 10.1016/j.euroneuro.2017.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
The quest for biomarkers in suicidal behaviors has been elusive so far, despite their potential utility in clinical practice. One of the most robust biological findings in suicidal behaviors is the alteration of the serotonin transporter function in suicidal individuals. Our main objective was to investigate the predictive value of the serotonin transporter gene expression (SLC6A4) for suicidal ideation and as secondary, for suicide attempts in individuals with a major depressive episode (MDE). A 30-week prospective study was conducted on 148 patients with a MDE and 100 healthy controls including 4 evaluation times (0, 2, 8 and 30 weeks). Blood samples and clinical data were collected and SLC6A4 mRNA levels were measured from peripheral blood mononuclear cells using RT-qPCR. We first demonstrated the stability and reproducibility of SLC6A4 mRNA expression measures over time in healthy controls (F=0.658; p=0.579; η2=0.008; ICC=0.91, 95% CI [0.87-0.94]). Baseline SLC6A4 expression level (OR=0.563 [0.340-0.932], p=0.026) as well as early changes in SLC6A4 expression between baseline and the 2nd week (β=0.200, p=0.042) predicted the worsening of suicidal ideation (WSI) in the following 8 weeks. Moreover, changes in SLC6A4 expression between the 2nd and 8th weeks predicted the occurrence of a suicide attempt within 30 weeks (OR=10.976 [1.438-83.768], p=0.021). Altogether, the baseline level and the changes in SLC6A4 mRNA expression during a MDE might predict the WSI and the occurrence of suicidal attempts and could be a useful biomarker in clinical practice.
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Affiliation(s)
- Julia-Lou Consoloni
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France
| | - El Chérif Ibrahim
- Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | | | - Xavier Zendjidjian
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, SPMC, EA 3279, Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France
| | - Emilie Olié
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; Inserm, U1061, University of Montpellier, Montpellier, France
| | | | - Thomas Desmidt
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France; Inserm U1253 Imaging & Brain, Université de Tours, Tours, France
| | - Ludovic Samalin
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Mocrane Abbar
- Department of Adult Psychiatry, CHRU Nimes, Nimes, France
| | - Jorge Lopez-Castroman
- Inserm, U1061, University of Montpellier, Montpellier, France; Department of Adult Psychiatry, CHRU Nimes, Nimes, France
| | - Emmanuel Haffen
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Clinical Psychiatry, University Hospital, Besançon, France; EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France; CIC-1431 Inserm, University Hospital, Besançon, France
| | - Karine Baumstarck
- Aix Marseille Univ, SPMC, EA 3279, Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France
| | - Jean Naudin
- APHM, Department of psychiatry, Marseille, France
| | - Jean-Michel Azorin
- APHM, Department of psychiatry, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France; Inserm U1253 Imaging & Brain, Université de Tours, Tours, France; Inserm CIC 1415, Centre d'Investigation Clinique, CHRU de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; Inserm, U1061, University of Montpellier, Montpellier, France
| | - Raoul Belzeaux
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.
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Cristancho P, O’Connor B, Lenze EJ, Blumberger DM, Reynolds CF, Dixon D, Mulsant BH. Treatment Emergent Suicidal Ideation in depressed older adults. Int J Geriatr Psychiatry 2017; 32:596-604. [PMID: 27162147 PMCID: PMC5102819 DOI: 10.1002/gps.4498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment-Emergent Suicidal Ideation (TESI) in older adults is poorly understood. We characterized TESI in older depressed adults during treatment with venlafaxine and explored whether TESI is related to antidepressant exposure versus dimensions of the psychiatric illness. We examined the relationship among medication exposure, onset of TESI, and clinical characteristics. METHODS We analyzed data on 233 clinical trial participants with major depression and no baseline suicidal ideation who were treated for up to 12 weeks with venlafaxine XR (target dose: 150-300 mg/day). Suicidal ideation was assessed weekly with the Scale for Suicide Ideation. A Kaplan-Meier curve displayed the time course of TESI. Differences in baseline demographic and clinical variables between the TESI and Non-TESI groups were assessed with analyses of covariance or logistic regression. A final multivariate logistic regression model indicated baseline predictors of TESI. Depression treatment outcomes in subjects developing TESI versus those who did not were examined with a mixed effects model. RESULTS TESI occurred in 10% of participants, typically with onset within 4 weeks of the start of treatment. Anxiety, and depression severity at baseline were predictors of TESI. Most TESI was mild and transient, with 6/233 participants having TESI considered clinically meaningful. TESI was not associated with venlafaxine blood levels or side effects. CONCLUSIONS In older depressed adults, TESI is relatively uncommon and it is likely related to the underlying illness rather than to a medication adverse effect. This suggests that TESI requires continuing rather than discontinuing antidepressant treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pilar Cristancho
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brendan O’Connor
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - David Dixon
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, University of Toronto, Toronto, CA
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Gaspersz R, Lamers F, Kent JM, Beekman ATF, Smit JH, van Hemert AM, Schoevers RA, Penninx BWJH. Anxious distress predicts subsequent treatment outcome and side effects in depressed patients starting antidepressant treatment. J Psychiatr Res 2017; 84:41-48. [PMID: 27693981 DOI: 10.1016/j.jpsychires.2016.09.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
Evidence has shown that the DSM-5 anxious distress specifier captures a clinically valid construct that predicts a worse clinical course. Although of importance for treatment planning and monitoring, however, the specifier's ability to predict treatment outcome is unknown. This is the first study to examine the ability of the DSM-5 anxious distress specifier to predict treatment response and side effects in depressed patients who recently initiated antidepressant treatment. Patients were from the Netherlands Study of Depression and Anxiety, an ongoing longitudinal cohort study. Baseline, 1-year and 2-year follow-up data were used from 149 patients (18-65 years) with current Major Depressive Disorder (MDD) who recently started adequately dosed antidepressant medication. Five self-report items were used to construct the DSM-5 anxious distress specifier. Treatment outcomes were depression severity after 1 year and 2 years, remission of MDD after 2 years and antidepressant side effects during treatment. For comparison, analyses were repeated for comorbid DSM-IV-based anxiety disorders as a predictor. In depressed patients who received antidepressant treatment, the anxious distress specifier (prevalence = 59.1%) significantly predicted higher severity (1 year: B = 1.94, P = 0.001; 2 years: B = 1.63, P = 0.001), lower remission rates (OR = 0.44, P = 0.0496) and greater frequency of side effects (≥4 vs. 0: OR = 2.74, P = 0.061). In contrast, the presence of comorbid anxiety disorders did not predict these treatment outcomes. The anxious distress specifier significantly predicts poorer treatment outcomes as shown by higher depression severity, lower remission rates, and greater frequency of antidepressant side effects in patients with MDD on adequate antidepressant treatment. Therefore, this simple 5-item specifier is of potential great clinical usefulness for treatment planning and monitoring in depressed patients.
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Affiliation(s)
- Roxanne Gaspersz
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Femke Lamers
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Justine M Kent
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Aartjan T F Beekman
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes H Smit
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
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21
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[Unsatisfactory response: definition and involvement]. Encephale 2016; 42:1S31-8. [PMID: 26879255 DOI: 10.1016/s0013-7006(16)30017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the worsening, the lack of response, partial response and poor tolerance. This lack of response may be related to intrinsic factors to the individual, but also to more extrinsic environmental factors. In this review, we explore this concept through its links with adherence and treatment duration. In this field, the concept of early response can be a powerful indicator of therapeutic response, which conditions the prescription of antidepressants beyond the strict framework of the sufficient period of 4 to 6 weeks. In addition to its impact on prognosis, the literature data show that the insufficient response is a significant burden in terms of medical and economic cost, and somatic comorbidity; and justifies a systematic identification of this dimension. Therefore self-reports (QIDS; BDI) will be preferred to the clinician-rated depression symptom rating scales (MADRS, HAMD) that require a specific training. Identifying predictors of non-response would be an attractive target for prescribers but the results to date are not operative.
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22
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Voegeli G, Ramoz N, Shekhtman T, Courtet P, Gorwood P, Kelsoe JR. Neurotrophin Genes and Antidepressant-Worsening Suicidal Ideation: A Prospective Case-Control Study. Int J Neuropsychopharmacol 2016; 19:pyw059. [PMID: 27378793 PMCID: PMC5137276 DOI: 10.1093/ijnp/pyw059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Antidepressant-worsening suicidal ideation is a rare but serious phenomenon. This study aimed to test for association between antidepressant-worsening suicidal ideation and polymorphisms of BDNF/NTRK2 neurotrophin pathway genes, known to be involved in depression and suicide. METHODS This was a case-control study comparing patients with antidepressant-worsening suicidal ideation to patients without. Patients were collected from the GENESE cohort (3771 depressed tianeptine-treated outpatients). Antidepressant-worsening suicidal ideation was defined by an increase of at least 2 points on the Montgomery-Åsberg Depression Rating Scale-item10 during treatment. Controls were matched for age, sex, and baseline Montgomery-Åsberg Depression Rating Scale-item10 score. Thirteen single nucleotide polymorphisms covering 5 BDNF/NTRK2 pathway genes were genotyped. RESULTS A total 78 cases and 312 controls were included. Two NTRK2 single nucleotide polymorphisms were associated to antidepressant-worsening suicidal ideation: rs1439050 (P=.01) and rs1867283 (P=.04). Association with rs1439050 remained significant after adjustment for potentially confounding factors, including previous suicide attempts (P<.01). CONCLUSIONS This naturalistic prospective study is consistent with previous studies on highlighting the potential role of the neurotrophin pathway, and especially of NTRK2, in antidepressant-worsening suicidal ideation.
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Affiliation(s)
- Géraldine Voegeli
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, CA (Drs Voegeli and Kelsoe); Department of Psychiatry (Dr Kelsoe), and Institute for Genomic Medicine (Ms Shekhtman and Dr Kelsoe), University of California San Diego, La Jolla, CA; INSERM U675, Center for Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France (Drs Voegeli, Ramoz, and Gorwood); CMME, Sainte-Anne Hospital, Paris, France (Drs Voegeli and Gorwood); Department of Emergency Psychiatry and Acute Care, CHRU Montpellier, Inserm U1061, University of Montpellier, Montpellier, France (Dr Courtet).
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23
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Lopez-Castroman J, Jaussent I, Gorwood P, Courtet P. SUICIDAL DEPRESSED PATIENTS RESPOND LESS WELL TO ANTIDEPRESSANTS IN THE SHORT TERM. Depress Anxiety 2016; 33:483-94. [PMID: 26882201 DOI: 10.1002/da.22473] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicidal thoughts and behaviors could be associated to a poor response to antidepressant treatment, but the exclusion of suicidal patients from randomized clinical trials restricts the available knowledge. In this study, we aimed at defining more precisely the response to antidepressants among suicidal patients and the threshold of suicidality that best predicts a poor response. METHOD We investigated the short-term response to a new antidepressant treatment of 4,041 depressed outpatients depending on their suicidal status (passive or active suicidal ideation (SI), history of suicide attempts [SAs]), either self-rated or clinician-rated. Depression outcomes, measured with the Hospital Anxiety and Depression Scale, and remission rates were compared depending on suicidal status at baseline using logistic regression models. RESULTS Using either a qualitative or a quantitative approach to measure SI, we found that suicidal patients were less likely to improve or attain remission, but not more likely to worsen, than nonsuicidal patients. In the multivariate analyses, SI (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.18-1.65) and a history of SA (OR = 1.39; 95% CI: 1.16-1.66) were the best predictors of nonremission, independently of the class of antidepressant treatment. CONCLUSION Antidepressant treatment seems to be less effective among those patients that need it most. Clinical trials including suicidal patients are needed to investigate specific treatment options.
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Affiliation(s)
- Jorge Lopez-Castroman
- Department of Psychiatry, CHRU Nimes, Nimes, France.,Inserm, U1061, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France
| | | | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital (CMME), Paris, France.,INSERM U894, (Center of Psychiatry and Neurosciences), Paris, France.,Department of Psychiatry, University Paris Descartes, Paris, France
| | - Philippe Courtet
- Inserm, U1061, Université Montpellier, Montpellier, France.,Fondamental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France
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24
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Sinclair S, Bryan CJ, Bryan AO. Meaning in Life as a Protective Factor for the Emergence of Suicide Ideation That Leads to Suicide Attempts Among Military Personnel and Veterans With Elevated PTSD and Depression. Int J Cogn Ther 2016. [DOI: 10.1521/ijct.2016.9.1.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lopez-Castroman J, Cerrato L, Beziat S, Jaussent I, Guillaume S, Courtet P. Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts. Drug Alcohol Depend 2016; 160:177-82. [PMID: 26832932 DOI: 10.1016/j.drugalcdep.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
AIMS Tobacco dependence and suicidal behaviors have been repeatedly associated in several studies but their relationship is still unclear. We aim to investigate, specifically, the association between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters, as well as the relationship of impulsivity with both conditions. METHODS We examined a cross-sectional sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence, which was assessed with the Fagerstrom test. RESULTS Smokers with heavy dependence (Fagerstrom ≥7) made more attempts and reached higher medical lethality compared to non-smokers. Smokers with moderate dependence were not associated with features of severity in the suicide attempts. The combination of high impulsivity and heavy tobacco dependence showed an additive effect on the number of suicide attempts. CONCLUSIONS A high or very high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts. Impulsive attempters with heavy tobacco dependence were particularly at risk.
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Affiliation(s)
- Jorge Lopez-Castroman
- Department of Psychiatry, CHRU Nimes, 585 Chemin du Mas de Lauze, 30029 Nîmes, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France.
| | - Laurent Cerrato
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France
| | - Severine Beziat
- Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Isabelle Jaussent
- Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France; Fondamental Foundation, 40 Rue de Mesly, 94000 Créteil, France
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26
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Baek JH, Heo JY, Fava M, Mischoulon D, Nierenberg A, Hong JP, Roh S, Jeon HJ. Anxiety symptoms are linked to new-onset suicidal ideation after six months of follow-up in outpatients with major depressive disorder. J Affect Disord 2015; 187:183-7. [PMID: 26342171 DOI: 10.1016/j.jad.2015.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Suicide risk evaluation is one of the most challenging assessments of patients with major depressive disorder (MDD). Initial risk evaluation might be insufficient in predicting emergence of suicidal ideation during the maintenance period. We aimed to elucidate factors associated with emergence or persistence of suicidal ideation 6 months after initiation of outpatient treatment in patients with MDD. METHODS A total of 300 participants with MDD defined by DSM-IV-TR criteria underwent face-to-face interview at baseline and follow-up phone interview at 6 months later. Severity of depression, suicidal ideation, and anxiety were evaluated. RESULTS Among participants who did not report any suicidal idea at baseline, 10.9% reported suicidal ideation during the 6-month phone interview, while 28.4% of participants who reported suicidal ideation at baseline reported suicidal ideation during the phone interview. No significant difference in remission rate of depression was observed between the groups, but subjects without suicidal ideation at baseline had a higher rate of symptom improvement at the 6-month phone interview. After controlling for age, sex, baseline severity of suicide risk and depression and lifetime history of suicide attempts, emergence of suicidal ideation was significantly associated with anxiety level at baseline (t=2.127, p=0.039) and severity of depression symptoms at 6 month (t=-3.028, p=0.004); persistence of suicidal ideation was associated with severity of depression symptoms at 6 month (t=-4.962, p<0.001). LIMITATION Follow-up evaluation was done by phone interview. CONCLUSION Anxiety at baseline needs to be carefully evaluated in assessing suicide risk of patients with MDD.
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Affiliation(s)
- Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jung Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Nierenberg
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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27
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AFPBN–Traitement du trouble conduite suicidaire. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Les troubles conduites suicidaires bénéficient d’une reconnaissance officielle dans le DSM-5. L’enjeu actuel vise à identifier les modalités de prise en charge de ces patients. Cette session abordera deux aspects thérapeutiques complémentaires, centrés sur les deux principaux facteurs de risque : tentative de suicide et dépression. G. Vaiva propose d’associer les différents types de recontact du suicidant pour élargir la cible de prévention. Plusieurs dispositifs ont été imaginés et testés, sans qu’aucun à lui seul ne se montre satisfaisant pour une majorité de suicidants en population générale. D’où l’idée d’un algorithme simple (ALGOS) qui pourrait allier les qualités de certains des dispositifs proposés : une carte de crise remise aux primosuicidants, l’appel téléphonique à 15 jours pour les sujets récidivistes, l’envoi de quelques cartes postales aux sujets injoignables ou trouvés en difficulté à l’appel téléphonique… M. Morgiève rendra compte d’une démarche sociologique d’évaluation de ce programme de veille des conduites suicidaires. Il s’agit ici de comprendre comment les différentes catégories d’acteurs (psychiatres, psychologues, généralistes, cellule de re-contact, urgentistes, suicidants eux-mêmes) ont pu se sentir impliqués dans ce programme. Une stratégie plus conventionnelle et familière aux psychiatres consiste à traiter la dépression. Si d’un côté, nombre d’arguments sont en faveur de l’intérêt de l’usage des antidépresseurs, les autorités de régulation nous alertent sur l’aggravation possible du risque suicidaire. Il faut néanmoins reconnaître que l’explosion des prescriptions d’antidépresseurs ne s’accompagne pas d’une diminution en rapport des conduites suicidaires. Où est le problème ? P. Courtet montrera que l’on dispose de facteurs prédictifs de l’aggravation du risque suicidaire dans les premières semaines de traitement. En outre, il présentera des données suggérant que les patients déprimés les plus à risque de suicide répondent moins bien aux antidépresseurs. Ceci indique la nécessité de traitements plus efficaces pour les patients qui en nécessitent le plus !
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Courtet P. Les antidépresseurs sont-ils vraiment bénéfiques ? Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
La dépression représente un facteur majeur de risque suicidaire. Il est légitime de proposer que traiter la dépression conduira à une réduction de l’incidence des conduites suicidaires (CS). En effet, des données quasi-expérimentales et épidémiologiques soutiennent cette hypothèse. Toutefois, les autorités de régulation nous alertent sur l’aggravation possible du risque suicidaire lors de l’utilisation des antidépresseurs, particulièrement chez les jeunes. Remarquons en outre que ces recommandations ont conduit à un rebond des conduites suicidaires non seulement chez les jeunes mais aussi chez les adultes. Il est donc indispensable d’étudier spécifiquement les mécanismes qui pourraient expliquer que chez certains sujets déprimés, la prescription d’antidépresseurs puissent aggraver le risque suicidaire. Nous présenterons les données de plusieurs grandes études de cohorte. D’une part, les facteurs prédictifs de l’aggravation du risque suicidaire dans les premières semaines de traitement sont la non-réponse au traitement et les antécédents de CS. En outre, des facteurs génétiques ont également été associés à l’émergence d’idées de suicide sous antidépresseurs. Réciproquement, nous avons observé que les patients déprimés les plus à risque de suicide, parce qu’ils présentent des idées de suicide ou des antécédents de CS, répondent moins bien aux antidépresseurs. Ceci indique la nécessité de traitements plus efficaces pour les patients qui en nécessitent le plus ! Des pistes intéressantes voient le jour pour offrir des traitements réduisant les idées de suicide chez des sujets en crise suicidaire. Il s’agit de la thérapie d’acceptation et d’engagement et de la kétamine.
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