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Bitter I, Szekeres G, Cai Q, Feher L, Gimesi-Orszagh J, Kunovszki P, El Khoury AC, Dome P, Rihmer Z. Mortality in patients with major depressive disorder: A nationwide population-based cohort study with 11-year follow-up. Eur Psychiatry 2024; 67:e63. [PMID: 39344202 DOI: 10.1192/j.eurpsy.2024.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disability and premature mortality. This study compared the overall survival (OS) between patients with MDD and non-MDD controls stratified by gender, age, and comorbidities. METHODS This nationwide population-based cohort study utilized longitudinal patient data (01/01/2010 - 12/31/2020) from the Hungarian National Health Insurance Fund database, which contains healthcare service data for the Hungarian population. Patients with MDD were selected and matched 1:1 to those without MDD using exact matching. The rates of conversion from MDD to bipolar disorder (BD) or schizophrenia were also investigated. RESULTS Overall, 471,773 patients were included in each of the matched MDD and non-MDD groups. Patients with MDD had significantly worse OS than non-MDD controls (hazard ratio [HR] = 1.50; 95% CI: 1.48-1.51; males HR = 1.69, 95% CI: 1.66-1.72; females HR = 1.40, 95% CI: 1.38-1.42). The estimated life expectancy of patients with MDD was 7.8 and 6.0 years less than that of controls aged 20 and 45 years, respectively. Adjusted analyses based on the presence of baseline comorbidities also showed that patients with MDD had worse survival than non-MDD controls (adjusted HR = 1.29, 95% CI: 1.28-1.31). After 11 years of follow-up, the cumulative conversions from MDD to BD and schizophrenia were 6.8 and 3.4%, respectively. Converted patients had significantly worse OS than non-converted patients. CONCLUSIONS Compared with the non-MDD controls, a higher mortality rate in patients with MDD, especially in those with comorbidities and/or who have converted to BD or schizophrenia, suggests that early detection and personalized treatment of MDD may reduce the mortality in patients diagnosed with MDD.
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Affiliation(s)
- Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gyorgy Szekeres
- Department of Psychiatry and Psychotherapy, Saint Rókus Hospital, Semmelweis University, Budapest, Hungary
| | - Qian Cai
- Janssen Global Services, LLC, Titusville, NJ, USA
| | | | | | | | | | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Nyiro Gyula National Institute for Psychiatry and Addictology, Budapest, Hungary
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Nyiro Gyula National Institute for Psychiatry and Addictology, Budapest, Hungary
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Suicide Preventive Interventions and Knowledge. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:178-179. [PMID: 37201137 PMCID: PMC10172550 DOI: 10.1176/appi.focus.23021002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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3
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Balint L, Osvath P, Kapitany B, Rihmer Z, Nemeth A, Dome P. Suicide in Hungary during the first year of the COVID-19 pandemic: Subgroup investigations. J Affect Disord 2023; 325:453-458. [PMID: 36642307 PMCID: PMC9836994 DOI: 10.1016/j.jad.2023.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND COVID-19 may unfavourably affect the mental health of individuals in various ways. Accordingly, the concern has been raised that national suicide rates will increase in the wake of the outbreak of the pandemic. METHODS In the current study, we tested this conjecture in three age groups (<25; 25-64; ≥65) of the Hungarian total population and the male and female populations. In addition, we assessed whether the pandemic had different effects on counts of suicides committed by violent or non-violent methods. Finally, by comparing the monthly suicide rates in 2020 and the corresponding monthly rates in 2019, we also investigated the "pulling together" hypothesis that postulates that a temporary decrease in suicides may occur after large-scale catastrophic events. RESULTS With regard to the total population only the suicide counts of individuals aged 25-64 rose significantly (p < 0.05) during the COVID months of 2020. Similar patterns, but at lower levels of significance (0.05 < p < 0.1), were found in those members of the total population aged 65 or older and among males aged between 25 and 64. Furthermore, we found that the number of violent suicides increased significantly (p < 0.05) during the COVID months. Finally, our results have not confirmed the existence of a "pulling together" phenomenon in association with the COVID-19 pandemic in Hungary. LIMITATIONS We used non-individual level data and were therefore unable to control suicide risk factors at the level of individuals. DISCUSSION The number of suicides rose significantly in some subgroups of the Hungarian population during the COVID months of 2020.
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Affiliation(s)
- Lajos Balint
- Demographic Research Institute of the Hungarian Central Statistical Office, Budapest, Hungary; Department of Sociology, University of Pecs, Pecs, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Balazs Kapitany
- Demographic Research Institute of the Hungarian Central Statistical Office, Budapest, Hungary
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Attila Nemeth
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
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Han JM, Choi WS, Choi H, Jang BH, Kim HJ, Son CH, Park JY, Kim YS, Jang HJ, Kim JH. Treatment of major depressive disorder (MDD) or dysthymic disorder (DD) in spinal cord injury (SCI) patients: a protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e055800. [PMID: 36517092 PMCID: PMC9756168 DOI: 10.1136/bmjopen-2021-055800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Although various treatments exist for depression in patients with spinal cord injury (SCI), the comparative effects and relationships between these treatments have not been clearly presented. This study aims to present comprehensive evidence for the treatment of major depressive disorder or dysthymic disorder in patients with SCI by comparing the therapeutic and adverse effects of pharmacological and non-pharmacological treatments through a systematic review and network meta-analysis. METHODS AND ANALYSIS We will search for studies in five databases (Medline, Central, Embase, PsycINFO and CHINAL) as well as clinical trial registries (US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www. CLINICALTRIALS gov), WHO International Clinical Trials Registry Platform (www.who.int/trialsearch)) and grey literature (Google Scholar). The references of the included studies, previous systematic reviews and meta-analyses will be reviewed. Study selection, data extraction and quality and risk of bias assessments will be independently performed by two authors (JMH and WSC), and disagreements will be resolved by discussion with JHK. Moreover, a Bayesian network meta-analysis will be performed using R software. ETHICS AND DISSEMINATION Our systematic review and network meta-analysis will be performed based on existing studies; thus, we did not seek ethical approval. Our results will be published in a peer-reviewed journal and presented at both domestic and international conferences.
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Affiliation(s)
- Ji Min Han
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Won Seuk Choi
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Hyun Choi
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Hyun-Jin Kim
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Chi Hyoung Son
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Ji Young Park
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Ye Soon Kim
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Hyo Jin Jang
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
| | - Jung Hwan Kim
- National Rehabilitation Center, Korea Ministry of Health and Welfare, Sejong, Korea (the Republic of)
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [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: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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Campos AI, Byrne EM, Iorfino F, Fabbri C, Hickie IB, Lewis CM, Wray NR, Medland SE, Rentería ME, Martin NG. Clinical, demographic, and genetic risk factors of treatment-attributed suicidality in >10,000 Australian adults taking antidepressants. Am J Med Genet B Neuropsychiatr Genet 2022; 189:196-206. [PMID: 35833543 PMCID: PMC9544797 DOI: 10.1002/ajmg.b.32913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022]
Abstract
Emergence of suicidal symptoms has been reported as a potential antidepressant adverse drug reaction. Identifying risk factors associated could increase our understanding of this phenomenon and stratify individuals at higher risk. Logistic regressions were used to identify risk factors of self-reported treatment-attributed suicidal ideation (TASI). We then employed classifiers to test the predictive ability of the variables identified. A TASI GWAS, as well as SNP-based heritability estimation, were performed. GWAS replication was sought from an independent study. Significant associations were found for age and comorbid conditions, including bipolar and personality disorders. Participants reporting TASI from one antidepressant were more likely to report TASI from other antidepressants. No genetic loci associated with TAS I (p < 5e-8) were identified. Of 32 independent variants with suggestive association (p < 1e-5), 27 lead SNPs were available in a replication dataset from the GENDEP study. Only one variant showed a consistent effect and nominal association in the independent replication sample. Classifiers were able to stratify non-TASI from TASI participants (AUC = 0.77) and those reporting treatment-attributed suicide attempts (AUC = 0.85). The pattern of TASI co-occurrence across participants suggest nonspecific factors underlying its etiology. These findings provide insights into the underpinnings of TASI and serve as a proof-of-concept of the use of classifiers for risk stratification.
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Affiliation(s)
- Adrian I. Campos
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia,School of Biomedical Sciences, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Institute for Molecular BioscienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Enda M. Byrne
- Institute for Molecular BioscienceThe University of QueenslandBrisbaneQueenslandAustralia,Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Frank Iorfino
- Brain and Mind CentreThe University of SydneyCamperdownNew South WalesAustralia
| | - Chiara Fabbri
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Ian B. Hickie
- Brain and Mind CentreThe University of SydneyCamperdownNew South WalesAustralia
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Naomi R. Wray
- Institute for Molecular BioscienceThe University of QueenslandBrisbaneQueenslandAustralia,Queensland Brain InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Sarah E. Medland
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Miguel E. Rentería
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia,School of Biomedical Sciences, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nicholas G. Martin
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
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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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Nobile B, Olié E, Dubois J, Guillaume S, Gorwood P, Courtet P. Characteristics and treatment outcome of suicidal depression: Two large naturalistic cohorts of depressed outpatients. Aust N Z J Psychiatry 2022; 56:347-364. [PMID: 34281409 DOI: 10.1177/00048674211025697] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The emergence of new drugs for managing suicidal ideation (e.g. ketamine) raises the question of whether suicidal depression (i.e. moderate to severe depression with concomitant suicidal ideation) is a specific depression phenotype. Therefore, this study characterized patients with suicidal depression (baseline clinical characteristics, suicidal ideation and depression evolutions, suicide risk) in two large cohorts of outpatients with depression. METHODS LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with depression (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria), treated and followed up for 6 weeks. Depression severity was assessed with the Hospital Anxiety and Depression Scale, and suicidal ideation with the suicidal item of the Montgomery-Åsberg Depression Rating Scale. Patients with moderate or severe depression (Hospital Anxiety and Depression Scale-Depression subscale score >11) were selected and classified as without suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale <2), with moderate suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale [2; 3]) and with severe suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale ⩾4). RESULTS Baseline clinical features were more severe (e.g. higher anxiety and depression scores) in depressed patients with moderate/severe suicidal ideation. Depression remission after treatment was less frequent among patients with severe suicidal ideation. The risk of suicide attempt during the follow-up was threefold higher in patients with suicidal ideation among those 10% had persistent suicidal ideation. CONCLUSION Suicidal depression could be a specific depression phenotype with more severe clinical characteristics, less frequent depression remission, suicidal ideation persistence and higher suicide attempt risk, despite antidepressant treatment. It seems that novel therapeutic strategies could be needed.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philip Gorwood
- Inserm UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
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Cigognini MA, Guirado AG, van de Meene D, Schneider MA, Salomon MS, de Alexandria VS, Adriano JP, Thaler AM, Fernandes FDS, Carneiro A, Moreno RA. Intramuscular ketamine vs. escitalopram and aripiprazole in acute and maintenance treatment of patients with treatment-resistant depression: A randomized double-blind clinical trial. Front Psychiatry 2022; 13:830301. [PMID: 35935445 PMCID: PMC9354749 DOI: 10.3389/fpsyt.2022.830301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, can promote rapid action in the management of individuals with treatment-resistant depression (TRD) at sub-anesthetic doses. However, few studies have investigated the long-term use of ketamine administered intravenously (IV) and intranasally (IN). We report the design and rationale of a therapeutic trial for assessing the efficacy, safety, and tolerability of repeated-dose intramuscular (IM) ketamine vs. active treatment (escitalopram and aripiprazole) in TRD patients. METHODS A comparative, parallel-group, randomized double-blind trial assessing the efficacy, safety, and tolerability of acute (4 weeks) and maintenance (24 weeks) use of IM ketamine (0.75 mg/kg) vs. active control (escitalopram 15 mg and aripiprazole 5 mg) in individuals with moderate-severe intensity TRD (no psychotic symptoms) with or without suicide risk will be conducted. Patients with TRD (18-40 years) will be randomized and blinded to receive ketamine IM or active treatment at a 1:1 ratio for 4 weeks (active treatment) and 24 weeks (maintenance treatment). Subjects will be assessed using clinical scales, monitored for vital signs (VS) after application of injectable medication, and undergo neuropsychological tests. The primary outcome will be changed on the Montgomery-Åsberg Depression Rating Scale (MADRS) during the course of the trial. The study is in running. RESULTS This study can potentially yield evidence on the use of IM ketamine in the treatment of depressive disorders as an ultra-rapid low-cost therapy associated with less patient discomfort and reduced use of medical resources, and can elucidate long-term effects on different outcomes, such as neuropsychological aspects. CONCLUSIONS The trial can help promote the introduction of a novel accessible approach for the treatment of complex disease (TRD) and also allow refinement of its long-term use. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04234776, identifier: NCT04234776.
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Affiliation(s)
- Marco Aurélio Cigognini
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Alia Garrudo Guirado
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Denise van de Meene
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Mônica Andréia Schneider
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Mônica Sarah Salomon
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Vinicius Santana de Alexandria
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Juliana Pisseta Adriano
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Maria Thaler
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Fernando Dos Santos Fernandes
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Adriana Carneiro
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Ricardo Alberto Moreno
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
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Liaugaudaite V, Naginiene R, Raskauskiene N, Mickuviene N, Bunevicius A, Sher L. Relationship between Lithium Levels in Drinking Water and Suicide Rates: A Nationwide Study in Lithuania. Arch Suicide Res 2021; 25:340-352. [PMID: 31596179 DOI: 10.1080/13811118.2019.1674226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To investigate an association of lithium levels in the drinking water with suicide mortality rates in Lithuania. Methods: Samples from public drinking water systems were taken in all districts of Lithuania. Lithium levels were determined using the ion chromatography method. For the statistical calculations, lithium levels were averaged per district municipality and plotted against suicide standardized mortality rates (SMR) per 100,000 populations, within the 5-year period from 2012 to 2016. Results: We found that lithium concentrations in drinking water were significantly negatively associated with total suicide rates in a nonlinear way. Conclusion: Lithium intake with drinking water may affect suicide rates in some geographical areas.
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11
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Chu H, Yang Y, Zhou J, Wang W, Qiu X, Yang X, Qiao Z, Song X, Zhao E. Social Support and Suicide Risk Among Chinese University Students: A Mental Health Perspective. Front Public Health 2021; 9:566993. [PMID: 33681117 PMCID: PMC7925394 DOI: 10.3389/fpubh.2021.566993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: World Health Organization recognizes suicide as a public health priority. This study aimed to investigate the risk life events which led university students to consider suicide and explore the protective mechanism of social support (including subjective support, objective support, and support utilization) on suicide risk. Methods: Three thousand nine hundred and seventy-two university students were recruited in Harbin, China. Social Support Rating Scale, Self-Rating Anxiety Scale, the Beck Depression Inventory, and the 25-item scale of suicide acceptability were used to collect participants' information. Descriptive statistics, Pearson's correlation, and mediation analysis were employed for statistical analysis. Results: "Drug addict," "infected with HIV," and "incurable illness" were the top three events that led university students to consider suicide. Social support played an important protective role against suicide risk. Subjective support and support utilization had total effects on suicide acceptability, including direct and indirect effects. Anxiety (indirect effect = -0.022, 95% CI = -0.037 ~ -0.009) and depressive symptoms (indirect effect = -0.197, 95% CI = -0.228 ~ -0.163) mediated the relationship between subjective support and suicide acceptability; meanwhile, the association between support utilization and suicide acceptability was mediated by anxiety (indirect effect = -0.054, 95% CI = -0.088 ~ -0.024) and depressive symptoms (indirect effect = -0.486, 95% CI = -0.558 ~ -0.422). However, the protective impact of objective support worked totally through decreasing anxiety (indirect effect = -0.018, 95% CI = -0.035 ~ -0.006) and depressive symptoms (indirect effect = -0.196, 95% CI = -0.246 ~ -0.143). Moreover, the mediation effects of depressive symptoms had stronger power than anxiety in the impact of social support on suicide risk. Conclusions: Among Chinese university students, suicide acceptability was elevated when there was a health scare. Social support effectively reduced suicide risk via decreasing anxiety and depressive symptoms. From the mental health perspective, families, peers, teachers, and communities should work together to establish a better social support system for university students, if necessary, help them to seek professional psychological services.
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Affiliation(s)
- Haiyun Chu
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Yanjie Yang
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Jiawei Zhou
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Wenbo Wang
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Xiaohui Qiu
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Xiuxian Yang
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Xuejia Song
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Erying Zhao
- Medical Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
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12
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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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13
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Korucu CÇ, Atay İM, Zayıf SS, Gültekin F. May nesfatin-1 be a state marker in major depressive disorder with suicidal ideation? Psychiatry Res 2018; 267:272-276. [PMID: 29940459 DOI: 10.1016/j.psychres.2018.05.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/05/2018] [Accepted: 05/29/2018] [Indexed: 12/17/2022]
Abstract
The best known effects of nesfatin-1 are on appetite and metabolic regulation. Moreover, several research suggest that nesfatin-1 play a role in stress responses. This molecule may be involved in the pathophysiology of mood disorders and suicidal behavior. We compared nesfatin-1 levels between depressed patients with suicidal ideation (n = 32, mean ± SD, 1,40 ± 0.11), without suicidal ideation(n = 31, 1.46 ± 0.14) and healthy controls (n = 32, 1.52 ± 0.13). Suicidal ideation was assessed with the Suicide Probability Scale, Scale for Suicide Ideation and depressive symptoms were evaluated with the Hamilton Depression Rating Scale. Blood samples were collected to measure serum nesfatin-1levels by using ELISA method. The study revealed that serum nesfatin-1 levels were significantly lower in MDD with suicidal ideation than in healthy volunteers (p < 0.001). There were a negative correlation between the scores of suicidal ideation and nesfatin-1 levels in MDD with SI group (r = -0.215; p = 0.016). In the future, nesfatin-1 levels may one day be applied in predicting and monitoring patients' suicide risk. Further prospective studies are required to elucidate this potential association.
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Affiliation(s)
- Cafer Çağrı Korucu
- Department of Psychiatry, Usak University Education and Research Hospital, Usak, Turkey.
| | - İnci Meltem Atay
- Department of Psychiatry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Seden Sert Zayıf
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Fatih Gültekin
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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14
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Smith KA, Cipriani A. Lithium and suicide in mood disorders: Updated meta-review of the scientific literature. Bipolar Disord 2017; 19:575-586. [PMID: 28895269 DOI: 10.1111/bdi.12543] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Suicide and suicidal behaviour are increased in mood disorders, particularly bipolar disorders. Observational studies and small randomized controlled trials (RCTs) support the idea that taking lithium is associated with a reduction in these rates. This paper aims to review the best evidence for the effect of lithium on rates of suicide and self harm. METHODS We searched PubMed, PsycINFO, and the Cochrane Library systematically for systematic reviews and meta-analyses of RCTs of lithium and suicide and self harm published between January 1980 and June 2017. In the case of multiple publications on the same topic, only the most recent or most comprehensive review was considered. RESULTS A large number of reviews were identified, but only 16 publications were systematic reviews. Of these, three systematic reviews of lithium and suicide rates and one of lithium and self harm confined only to RCTs were identified. Despite some methodological concerns and heterogeneity in terms of participants, diagnoses, comparators, durations, and phase of illness, the evidence to date is overwhelmingly in favour of lithium as an antisuicidal agent, even balanced against any potential disadvantages of its use in regular clinical practice. CONCLUSIONS The anti-suicidal effects of lithium have been consistently reported over the past 40 years. The most robust evidence comes from RCTs, but these results are also discussed in the context of the difficulties in conducting high quality studies in this area, and the supporting evidence that observational and non-randomized studies can also provide. Given this evidence, however, the use of lithium is still underrepresented in clinical practice and should be incorporated more assertively into current guidelines.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Liaugaudaite V, Mickuviene N, Raskauskiene N, Naginiene R, Sher L. Lithium levels in the public drinking water supply and risk of suicide: A pilot study. J Trace Elem Med Biol 2017; 43:197-201. [PMID: 28385387 DOI: 10.1016/j.jtemb.2017.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 01/27/2023]
Abstract
Suicide is a major public health concern affecting both the society and family life. There are data indicating that higher level lithium intake with drinking water is associated with lower suicide rate. This pilot study examined the relationship between lithium levels in drinking water and suicide rates in Lithuania. Twenty-two samples from public drinking water systems were taken in 9 cities of Lithuania. The lithium concentration in these samples was determined by inductively coupled plasma mass spectrometry (ICP-MS). The suicide data were obtained from the Lithuania Database of Health Indicators, and comprised all registered suicides across all ages and gender within the 5-year period from 2009 to 2013. The study demonstrated an inverse correlation between levels of lithium (log natural transformed), number of women for 1000 men and standardized mortality rate for suicide among total study population. After adjusting for confounder (the number of women for 1000 men), the lithium level remained statistically significant in men, but not in women. Our study suggested that higher levels of lithium in public drinking water are associated with lower suicide rates in men. It might have a protective effect on the risk of suicide in men.
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Affiliation(s)
- Vilma Liaugaudaite
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Narseta Mickuviene
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Nijole Raskauskiene
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Rima Naginiene
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chan HW, Huang CY, Feng WJ, Yen YC. Clinical outcomes of long-acting injectable risperidone in patients with bipolar I disorder: A 1-year retrospective cohort study. J Affect Disord 2016; 205:360-364. [PMID: 27568173 DOI: 10.1016/j.jad.2016.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/04/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We explored the effect of risperidone long-acting injection (LAI) treatment on patients with bipolar I disorder in a real-world setting. METHODS In this retrospective cohort study, 469 patients with bipolar I disorder were enrolled and treated with risperidone LAI and different oral antipsychotics and followed for 1 year. Concomitant medications, such as mood stabilizers, antidepressant, anxiolytics, hypnotics, or anticholinergics, were administered. On the basis of risperidone LAI use and treatment compliance, the patients were classified into 4 groups: the first long-acting injectable antipsychotics (LAI1) group (compliant patients receiving risperidone LAI treatment) (N=44), the second long-acting injectable antipsychotics (LAI2) group (non-compliant patients receiving risperidone LAI treatment) (N=33), the first non-LAI (NLAI1) group (compliant patients receiving oral medications) (N =337), and the second non-LAI (NLAI2) group (non-compliant patients receiving oral medications) (N=55). The rate of re-hospitalization, length of hospital stay, and rate of emergency room visit were assessed. RESULTS Compared with the non-LAI groups, the LAI groups had longer mean duration of illness (8.5 years, P=0.0001), higher rate of admission due to mood episodes (P<0.0001), depressive episodes (P<0.0001), or manic episodes (P=0.0002), and higher rate of emergency room visit (P=0.0003) before enrollment. After a 1-year follow-up, re-hospitalization rates were significantly lower in the LAI1 group than that before enrollment for any episodes (P=0.0001), manic episodes (P=0.005), and depressive episodes (P=0.002). The rates of emergency room visit were significantly lower in the LAI1 (P=0.0001), LAI2 (P=0.013), and NLAI1 (P=0.0001) groups compared with those before enrollment. CONCLUSIONS Risperidone LAI reduces the clinical severity of bipolar I disorder.
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Affiliation(s)
- Hsue-Wei Chan
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan; Graduate Institute of Health Care Administration, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chin-Yu Huang
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Jui Feng
- Departments of Administrative Management, China Medical University Hospital, Taichung, Taiwan; Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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17
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Abstract
OBJECTIVES Homicide is overwhelmingly committed by men compared to women. Conservative estimates suggest that more than a third of these individuals have a treatable psychiatric disorder. These data present an opportunity to mental health clinicians to assist in the prevention of homicide by improving men's mental health. METHODS We review the current literature on men's mental health with a focus on assessing and reducing homicide risk in men with psychiatric conditions. RESULTS Bipolar disorder and schizophrenia appear to share a neural endophenotype that is a risk factor for homicide. Dual disorders, or the presence of a substance use disorder with other major mental illness, are a major risk factor for homicide in males. Dual diagnosis disorders, personality disorders and pathological traits and male depression share emotion dysregulation, irritability, and reactive aggression. Promoting physician education, addressing firearm safety, reducing the reluctance of men relative to women to engage in help-seeking behaviour, and using targeted risk interviews which integrate these data are all currently recommended. CONCLUSIONS The main focus in prevention of homicidal behaviour in males with psychiatric disorders should be to identify high risk groups, to provide adequate treatment, and to facilitate compliance with long-term treatment while considering male specific problems and needs.
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Affiliation(s)
- Leo Sher
- Icahn School of Medicine at Mount Sinai , New York , USA
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18
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Rihmer Z. Pharmacologial Prevention of Suicide. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Otuyelu E, Foldvari A, Szabo E, Sipos V, Edafiogho P, Szucs M, Dome P, Rihmer Z, Sandor J. Antidepressant drugs and teenage suicide in Hungary: Time trend and seasonality analysis. Int J Psychiatry Clin Pract 2015; 19:221-5. [PMID: 26058968 DOI: 10.3109/13651501.2015.1061017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the relationship between increasing utilization of antidepressants and lithium, and suicide rate of persons less than 20 years of age in Hungary, with particular regard to seasonal patterns. METHODS Time trend analysis was carried out to determine the correlation between antidepressant and lithium prescription patterns in Hungarian persons under age of 20 years as well as seasonal variations within the study period from January 1998 to December 2006. RESULTS There was a significant correlation (P = 0.03) between the eight-fold increase in antidepressant + lithium prescriptions and decreasing suicides in young Hungarian people under 20 years of age within the study period. Lithium, selective serotonin reuptake inhibitors (SSRIs) and the group of "other antidepressant drugs" rather than nonselective monoamine reuptake inhibitors and monoamine oxidase-A inhibitors were responsible for this association. No significant association could be drawn from seasonal variation with boys (P = 0.964), girls (P = 0.140), or both genders (P = 0.997). LIMITATION Ecological study design. CONCLUSION Our findings are in good agreement with large-scale ecological studies showing that the beneficial effect of more widely used antidepressants at a given point could appear on the level of suicide rate of the general population even among patients under the age of 20 years.
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Affiliation(s)
- Ekundayo Otuyelu
- a Department of Epidemiology and Biostatistics , School of Public Health, University of Debrecen, Medical and Health Science Center , Debrecen , Hungary
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20
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Abstract
Objective: To provide a clinical overview of the antidepressant levomilnacipran. Data Sources: Articles were identified by searching the MEDLINE, PubMed, Cochrane Library, and Clinicaltrials.gov databases through March 2014 using the keyword levomilnacipran. The manufacturer provided additional information from unpublished phase II and phase III trials. Study Selection and Data Extraction: Any clinical trial conducted for at least 3 weeks and published in the English language was selected for review. Additional documentation, including the product dossier, package insert, pharmacokinetic studies, and poster presentations supplied by the manufacturer, was also evaluated. Data Synthesis: Levomilnacipran is the more potent enantiomer of milnacipran. It is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), dosed from 20 to 120 mg daily for the treatment of major depressive disorder (MDD). Efficacy and tolerability were established during 3 phase III randomized, double-blind placebo-controlled trials finding levomilnacipran to be significantly more efficacious than placebo in reduction of Montgomery-Åsberg Depression Rating Scale scores. It is not known whether this agent is more efficacious than other antidepressants because direct comparison studies have not been conducted as of the time of this review. Conclusions: Levomilnacipran demonstrates efficacy and tolerability for short-term treatment of MDD in adults. Available evidence does not strongly indicate that there is a specific subpopulation of patients who would benefit from levomilnacipran over currently available SNRIs. Full characterization of the agent’s place in therapy alongside multiple other agents with similar mechanisms and efficacy requires trials with longer duration and active comparators.
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Affiliation(s)
- Emma C. Palmer
- Sullivan University College of Pharmacy, Louisville, KY, USA
| | - Lindsey N. Binns
- Southern Arizona Veterans Affairs Healthcare System, Tucson, AZ, USA
| | - Heather Carey
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
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