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Wisłowska-Stanek A, Kołosowska K, Maciejak P. Neurobiological Basis of Increased Risk for Suicidal Behaviour. Cells 2021; 10:cells10102519. [PMID: 34685499 PMCID: PMC8534256 DOI: 10.3390/cells10102519] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/25/2022] Open
Abstract
According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.
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Affiliation(s)
- Aleksandra Wisłowska-Stanek
- Centre for Preclinical Research and Technology (CEPT), Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland;
- Correspondence: ; Tel.: +48-221166160
| | - Karolina Kołosowska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland;
| | - Piotr Maciejak
- Centre for Preclinical Research and Technology (CEPT), Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 1B Banacha Street, 02-097 Warsaw, Poland;
- Department of Neurochemistry, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland;
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Michel K, Gysin-Maillart A, Breit S, Walther S, Pavlidou A. Psychopharmacological treatment is not associated with reduced suicide ideation and reattempts in an observational follow-up study of suicide attempters. J Psychiatr Res 2021; 140:180-186. [PMID: 34118635 DOI: 10.1016/j.jpsychires.2021.05.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disorders of mental health are major risk factors for suicidal behavior and require adequate treatment. However, the effect of psychotropic medication on suicidal behavior is unclear. METHODS The 120 participants in a randomized clinical trial of a brief therapy for suicide attempters (Attempted Suicide Short Intervention Program, ASSIP) reported on repeated suicide attempts, suicidal ideation, depression, and medication in the treatment as usual (TAU), at baseline, 6, 12, 18, and 24 months follow-up. The RCT had no influence on medication prescribed. Drugs prescribed were categorized as any psychotropic, antidepressants plus lithium, and antipsychotics. To assess the effect of long-term medication we identified participants with periods of continuous use of psychotropics and antidepressants plus lithium over twelve months or more, and medication-free participants for the same drug categories during the same time period. RESULTS Reattempts and suicide ideation decreased in all drug categories. When comparing participants on medication fulfilling the definition of long-term use with participants without medication, reattempts and suicidal ideation were higher in the psychotropics and the antidepressants/lithium groups. These drug categories were associated with higher depression scores in comparison to no-medication. The survival analysis revealed a higher risk of reattempts in the long-term antidepressants/lithium group in comparison to no-medication. Treatment with the brief psychological therapy ASSIP, added to medication, was associated with a lower risk of reattempts. LIMITATIONS The study relied on the patients' reports on treatment as usual in a randomized controlled clinical trial. Blood levels of the psychotropic compounds were not assessed. CONCLUSIONS In this observational study of the TAU condition in a clinical trial of a brief psychological therapy for patients who had recently attempted suicide, psychotropic drug use over twelve months or more was not associated with reduced suicide ideation and reattempts. Depression scores suggest that patients on psychotropic medication had more psychiatric pathology. This may be a confounding factor for the effect of medication on suicidal behavior.
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Affiliation(s)
- Konrad Michel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Anja Gysin-Maillart
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Sigrid Breit
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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Lerner A, Klein M. Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Commun 2019; 1:fcz025. [PMID: 32954266 PMCID: PMC7425303 DOI: 10.1093/braincomms/fcz025] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
The purpose of this article is to describe dependence and withdrawal phenomena related to CNS drugs discontinuation and to clarify issues related to the evaluation of clinical drug withdrawal and rebound as they relate to safety in new drug development. The article presents current understanding and definitions of drug dependence and withdrawal which are also relevant and important features of addiction, though not the same. Addiction, called substance use disorder in DSM-5, affects an individual’s brain and behaviour, represents uncontrollable drug abuse and inability to stop taking a drug regardless of the harm it causes. Characteristic withdrawal syndromes following abrupt discontinuation of CNS-active drugs from numerous drug classes are described. These include drugs both scheduled and non-scheduled in the Controlled Substances Act, which categorizes drugs in five schedules based on their relative abuse potentials and dependence liabilities and for regulatory purposes. Schedules 1 and 2 contain drugs identified as those with the highest abuse potential and strictest regulations. Less recognized aspects of drug withdrawal, such as rebound and protracted withdrawal syndromes for several drug classes are also addressed. Part I presents relevant definitions and describes clinical withdrawal and dependence phenomena. Part II reviews known withdrawal syndromes for the different drug classes, Part III describes rebound and Part IV describes protracted withdrawal syndromes. To our knowledge, this is the first compilation of withdrawal syndromes for CNS drugs. Part V provides details of evaluation of dependence and withdrawal in the clinical trials for CNS drugs, which includes general design recommendations, and several tools, such as withdrawal questionnaires and multiple scales that are helpful in the systematic evaluation of withdrawal. The limitations of different aspects of this method of dependence and withdrawal evaluation are also discussed.
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Affiliation(s)
- Alicja Lerner
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993-0002, USA
- Correspondence to: Alicja Lerner, MD, PhD, FDA Controlled Substance Staff, Center for Drug Evaluation and Research, Food and Drug Administration 10903 New Hampshire Avenue, Building 51 Silver Spring, MD 20993-0002, USA E-mail:
| | - Michael Klein
- Controlled Substance Scientific Solutions LLC, 4601 North Park Avenue #506, Chevy Chase, MD 20815-4572, USA
- Correspondence may also be addressed to: Michael Klein, PhD Controlled Substance Scientific Solutions LLC 4601 North Park Avenue #506 Chevy Chase, MD 20815-4572 USA E-mail:
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Castelpietra G, Bortolussi L, Gobbato M, Arnoldo L, Balestrieri M, Wettermark B. Discontinuation of antidepressants in suicides findings from the Friuli Venezia Giulia Region, Italy, 2005‐2014. Basic Clin Pharmacol Toxicol 2018; 124:312-320. [DOI: 10.1111/bcpt.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Giulio Castelpietra
- Primary Care Services Area Central Health Directorate, Friuli Venezia Giulia Region Trieste Italy
- Department of Medicine, Surgery and Health Sciences University of Trieste Trieste Italy
| | - Luca Bortolussi
- Department of Mathematics and Geosciences University of Trieste Trieste Italy
| | - Michele Gobbato
- Epidemiological Service Trust for the Centralised Management of Shared Services (EGAS) Udine Italy
| | - Luca Arnoldo
- Department of Medical and Biological Sciences University of Udine Udine Italy
| | - Matteo Balestrieri
- Department of Medical and Biological Sciences University of Udine Udine Italy
| | - Bjorn Wettermark
- Department of Medicine Centre for Pharmacoepidemiology Karolinska Institutet Stockholm Sweden
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De Berardis D, Fornaro M, Valchera A, Cavuto M, Perna G, Di Nicola M, Serafini G, Carano A, Pompili M, Vellante F, Orsolini L, Fiengo A, Ventriglio A, Yong-Ku K, Martinotti G, Di Giannantonio M, Tomasetti C. Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors. Int J Mol Sci 2018; 19:E2888. [PMID: 30249029 PMCID: PMC6213585 DOI: 10.3390/ijms19102888] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 12/22/2022] Open
Abstract
Despite the continuous advancement in neurosciences as well as in the knowledge of human behaviors pathophysiology, currently suicide represents a puzzling challenge. The World Health Organization (WHO) has established that one million people die by suicide every year, with the impressive daily rate of a suicide every 40 s. The weightiest concern about suicidal behavior is how difficult it is for healthcare professionals to predict. However, recent evidence in genomic studies has pointed out the essential role that genetics could play in influencing person's suicide risk. Combining genomic and clinical risk assessment approaches, some studies have identified a number of biomarkers for suicidal ideation, which are involved in neural connectivity, neural activity, mood, as well as in immune and inflammatory response, such as the mammalian target of rapamycin (mTOR) signaling. This interesting discovery provides the neurobiological bases for the use of drugs that impact these specific signaling pathways in the treatment of suicidality, such as ketamine. Ketamine, an N-methyl-d-aspartate glutamate (NMDA) antagonist agent, has recently hit the headlines because of its rapid antidepressant and concurrent anti-suicidal action. Here we review the preclinical and clinical evidence that lay the foundations of the efficacy of ketamine in the treatment of suicidal ideation in mood disorders, thereby also approaching the essential question of the understanding of neurobiological processes of suicide and the potential therapeutics.
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Affiliation(s)
- Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "G. Mazzini" Hospital, p.zza Italia 1, 64100 Teramo, Italy.
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Michele Fornaro
- Polyedra Research Group, 64100 Teramo, Italy.
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine 'Federico II' Naples, 80121 Naples, Italy.
| | - Alessandro Valchera
- Polyedra Research Group, 64100 Teramo, Italy.
- Villa S. Giuseppe Hospital, Hermanas Hospitalarias, 63100 Ascoli Piceno, Italy.
| | - Marilde Cavuto
- Department of Theory, Analysis and Composition, Music Conservatory "L. Canepa", 07100 Sassari, Italy.
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, 22032 Como, Italy.
- Department of Psychiatry and Neuropsychology, University of Maastricht, 6221 Maastricht, The Netherlands.
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Coral Gables, FL 33114, USA.
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, 00118 Rome, Italy.
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy.
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", A.S.U.R. 12, 63074 San Benedetto del Tronto, Italy.
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 00118 Rome, Italy.
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Laura Orsolini
- Polyedra Research Group, 64100 Teramo, Italy.
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield SG141LZ, UK.
| | - Annastasia Fiengo
- Polyedra Research Group, 64100 Teramo, Italy.
- NHS, Department of Mental Health ASUR Marche AV5, Mental Health Unit, 63100 Ascoli Piceno, Italy.
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy.
| | - Kim Yong-Ku
- Department of Psychiatry, Korea University College of Medicine, Seoul 08826, Korea.
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Carmine Tomasetti
- Polyedra Research Group, 64100 Teramo, Italy.
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine 'Federico II' Naples, 80121 Naples, Italy.
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Positive and Negative Suicide Ideation (PANSI) Inventory: Initial Psychometric Properties as a Suicide Risk Screening Tool Among Nigerian University Students. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1179557317751910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The objective of this study is to examine the factor structure, validity, reliability, and the screening properties as a suicide risk assessment tool of the 14-item Positive and Negative Suicide Ideation (PANSI) in a nonclinical sample of Nigerian university students. Methods: A total of 514 students completed the PANSI, in addition to the Beck Depression Inventory-II (BDI-II) and the General Health Questionnaire-12 (GHQ-12). Results: Prior to the factor analysis, the sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the inventory yielded a 2-factor model (Negative Suicide Ideation [PANSI-NSI] and Positive Ideation [PANSI-PI]), whereas confirmatory factor analysis in the other half (sample 2) produced a 2-factor model with indices of fitness that indicated a satisfactory model fit ( c2 = 93.8; df = 67; χ2/degree of freedom = 1.400; P = .017; goodness of fit index = 0.951; Tucker-Lewis index = 0.964; comparative fit index = 0.974; root mean square error of approximation = 0.040). The internal consistencies of the items of the PANSI-PI and PANSI-NSI subscales were 0.75 and 0.79, respectively. The construct validity of the 2 subscales was modestly satisfactory: PANSI-PI had negative correlations with the GHQ-12 ( r = −.239, P < .001) and the BDI-II ( r = −.190, P < .001), whereas the PANSI-NSI had positive correlations with the GHQ-12 ( r = .248, P < .001) and the BDI-II ( r = .376, P < .001). In addition, a cutoff total score of 17 on the PANSI-NSI was associated with the best sensitivity (80.0%) and specificity (92.5%) in the identification of those students who endorsed experiencing suicidal ideation (area under the curve = 0.82, 95% confidence interval = 0.58-1.00). Conclusions: The PANSI has exhibited satisfactory psychometric properties as a self-rated suicidal behavior assessment instrument in the evaluation of the positive and negative thoughts associated with suicidal ideation among Nigerian university students.
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Fountoulakis KN, Yatham L, Grunze H, Vieta E, Young A, Blier P, Kasper S, Moeller HJ. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. Int J Neuropsychopharmacol 2017; 20:121-179. [PMID: 27816941 PMCID: PMC5409012 DOI: 10.1093/ijnp/pyw100] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 02/05/2023] Open
Abstract
Background The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. Material and Methods The PRISMA method was used in the literature search with the combination of the words 'bipolar,' 'manic,' 'mania,' 'manic depression,' and 'manic depressive' with 'randomized,' and 'algorithms' with 'mania,' 'manic,' 'bipolar,' 'manic-depressive,' or 'manic depression.' Relevant web pages and review articles were also reviewed. Results The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. Conclusions A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
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Al Jurdi RK, Swann A, Mathew SJ. Psychopharmacological Agents and Suicide Risk Reduction: Ketamine and Other Approaches. Curr Psychiatry Rep 2015; 17:81. [PMID: 26307033 DOI: 10.1007/s11920-015-0614-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Suicide is a major global public health problem and the leading cause of injury mortality in the USA. Suicide is a complex phenomenon involving several systems and neurobiological pathways, with interacting genetic and environmental mechanisms. The literature on the neurobiology and pharmacotherapy of suicide has been limited. To date, no medications have proven efficacious for treating acute suicidal crises. There is an emerging literature supporting a rapid anti-suicidal effect of ketamine, a non-competitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, among depressed patients with suicidal ideation. Potential ketamine's anti-suicidal effect mechanisms are linked to interruption of the kynurenine pathway and modulating pro-inflammatory cytokines exacerbation. However, available data are not sufficient for its routine integration in clinical practice, and larger and replicated randomized control studies are needed.
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Affiliation(s)
- Rayan K Al Jurdi
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd MHCL 116, Houston, TX, 77030, USA,
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Rihmer Z, Gonda X. Pharmacological prevention of suicide in patients with major mood disorders. Neurosci Biobehav Rev 2013; 37:2398-403. [DOI: 10.1016/j.neubiorev.2012.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/10/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
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Yerevanian BI, Choi YM. Impact of psychotropic drugs on suicide and suicidal behaviors. Bipolar Disord 2013; 15:594-621. [PMID: 23869907 DOI: 10.1111/bdi.12098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders. METHODS A Medline search of articles published from January 1960 to January 2013 was performed using relevant keywords to identify studies examining the relationship of psychotropic drugs to suicidal behaviors. The publications were further reviewed for relevant references and information. Additionally, the US Food and Drug Administration Center for Drug Evaluation Research website was searched. RESULTS The available studies used differing methodologies, making interpretation of the findings difficult. Studies suggest that antidepressants may increase suicidal risk in bipolar disorder, this possibly being related to the induction of broadly defined mixed states. There is no evidence that antiepileptic drugs as a class increase suicidal risk in patients with bipolar disorder. Only lithium provides convincing data that it reduces the risk of suicide over the long term. There is little known regarding the effects of antipsychotics, as well as anti-anxiety and hypnotic drugs, on suicidal behavior. CONCLUSIONS The available evidence for the impact of psychotropics on suicidal risk in patients with bipolar disorder is largely methodologically flawed and, except for a few instances, clinically not useful at this point. Adequately powered, prospective randomized controlled studies are needed to assess the impact of each class of psychotropic and each psychotropic as well as common combination therapies. Until such studies have been carried out, clinicians are urged to exercise caution in using these drugs and rely on the traditional means of carefully assessing and monitoring patients with bipolar disorder who are at high risk for suicide.
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Affiliation(s)
- Boghos I Yerevanian
- Department of Psychiatry, Greater Los Angeles VA Healthcare System, Sepulveda Ambulatory Care Center, North Hills, CA 91343, USA.
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Abstract
Analytical toxicology is a complex discipline. Simply detecting a poison in a biological sample does not necessarily mean that the individual from whom the sample was obtained had been poisoned. An analysis can prove exposure and perhaps give an indication of the magnitude of exposure, but the results have to be placed in proper context. Even if sampling was ante-mortem an analysis does not necessarily prove the effects that the drug or poison had on the victim immediately before or at the time of sampling. Tolerance is one big issue, the mechanism of exposure (how the drug got into the body) is another, and of course with post-mortem work there are always additional considerations such as site of sample collection and the possibility of post-mortem change in analyte concentration. There are also questions of quality and reliability, and whether a particular analysis and the interpretation placed upon the result are appropriate in a particular case.
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Wasserman D, Rihmer Z, Rujescu D, Sarchiapone M, Sokolowski M, Titelman D, Zalsman G, Zemishlany Z, Carli V. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur Psychiatry 2011; 27:129-41. [PMID: 22137775 DOI: 10.1016/j.eurpsy.2011.06.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/07/2011] [Accepted: 06/13/2011] [Indexed: 10/14/2022] Open
Abstract
UNLABELLED Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. SUICIDAL CRISIS: Acute intervention should start immediately in order to keep the patient alive. DIAGNOSIS An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. TREATMENT Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. TREATMENT TEAM: Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. FAMILY: The suicidal person independently of age should always be motivated to involve family in the treatment. SOCIAL SUPPORT: Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. SAFETY A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. TRAINING OF PERSONNEL: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.
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Affiliation(s)
- D Wasserman
- The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
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General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 3:207-45. [PMID: 22033583 DOI: 10.1007/s00406-011-0259-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.
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Norra C, Richter N, Juckel G. Sleep disturbances and suicidality: a common association to look for in clinical practise and preventive care. EPMA J 2011; 2:295-307. [PMID: 23199165 PMCID: PMC3405392 DOI: 10.1007/s13167-011-0101-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/01/2011] [Indexed: 01/10/2023]
Abstract
Suicidality and suicide has been associated with many risk factors, while recent clinical and epidemiological studies increasingly point to a potential link between sleep loss or sleep disturbances and suicidality. This review on studies of sleep disturbances associated with suicidality, i.e., suicidal ideation, suicide attempt and completed suicide suggests a frequent association especially with insomnia and nightmares but also hypersomnia and sleep panic attacks. In suicidal insomniacs with comorbid psychiatric disorders, there is some evidence for an even independent predictive nature of sleep problems for suicidality. Considerations on the shared neurobiology, risk assessment and treatment options complement the overview. Thus, sleep disturbances may qualify as an individual treatable target of personalised medicine in the clinical routine as well as in suicide prevention programmes. A more detailed assessment of sleep problems and identification of specific risk domains in primary or secondary prevention of suicidality seem to be a future area of high importance.
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Affiliation(s)
- Christine Norra
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Nadja Richter
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
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Morehouse R, Macqueen G, Kennedy SH. Barriers to achieving treatment goals: a focus on sleep disturbance and sexual dysfunction. J Affect Disord 2011; 132 Suppl 1:S14-20. [PMID: 21575992 DOI: 10.1016/j.jad.2011.03.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients who meet the criteria for a major depressive episode experience a constellation of symptoms, and different symptom configurations may reflect distinct underlying neurological disturbances. Similarly, the differing receptor profiles of the various antidepressants may explain relatively low remission rates and persistent symptoms even after remission. In particular, depressed patients frequently display altered circadian rhythms, sleep disturbances, and diurnal mood variation. Exploring treatments that can restore mood while having a positive impact on circadian rhythms and sleep would greatly improve the ability to treat this core features of depression. METHODS The mechanisms of action of the various classes of antidepressants, their effects on sleep and issues beyond sleep, including sexual dysfunction, are explored, along with questions relating to adherence. RESULTS Unfortunately, persistent sleep problems are among the most difficult-to-treat residual symptoms of depression. Many of the currently available antidepressants have adverse effects on circadian processes, including sleep, and may actually worsen sleep problems. Tolerability is also an enduring issue; SSRI and SNRI antidepressants are associated with central nervous sysytem and gastrointestinal effects, sexual side effects and suicidality. Improved drug tolerability would not only minimize distressing adverse effects, but would also improve adherence, thus maximizing the chances of successful treatment. CONCLUSIONS The complexity of managing a major depressive episode is well illustrated by sleep disturbance and sexual dysfunction, two core symptoms of MDD that may also be caused or exacerbated by antidepressant therapy. Future antidepressants should alleviate symptoms without adversely affecting sleep or sexual function.
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Affiliation(s)
- Rachel Morehouse
- Department of Psychiatry, Dalhousie University (Dalhousie Medicine New Brunswick), Saint John, NB, Canada.
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Antidepressant therapy in severe depression may have different effects on ego-dystonic and ego-syntonic suicidal ideation. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:896395. [PMID: 21738871 PMCID: PMC3123969 DOI: 10.1155/2011/896395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/13/2011] [Indexed: 11/18/2022]
Abstract
The objective of the present study was to investigate whether ego-dystonic and ego-syntonic suicidal ideation occurred at different frequencies during antidepressant therapy. A blind evaluation has been performed on records of 100 suicides with a primary severe depression and 100 matched controls, admitted to the Department of Psychiatry, Lund, Sweden. Ego-dystonic suicidal ideation was more commonly reported during adequate treatment as compared to ego-syntonic ideation (P = .004). Men who committed suicide during adequate antidepressant therapy more often reported ego-dystonic suicidal ideation earlier in their lives compared with those who were not treated (P = .0377). This may indicate that treatment failure for ego-dystonic ideation was a precursor of their suicides. Consequently, ego-dystonic ideation seems to show a poorer response to antidepressant therapy as compared to ego-syntonic ideation, which may be more directly related to depression. Ego-dystonic ideation is proposed to be related to depressive psychosis.
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Hunter AM, Leuchter AF, Cook IA, Abrams M. Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood symptoms during antidepressant treatment. Acta Psychiatr Scand 2010; 122:461-9. [PMID: 20384600 DOI: 10.1111/j.1600-0447.2010.01560.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Antidepressant medications are efficacious overall; however, some individuals experience worsening mood symptoms and increased suicidal ideation (SI) during treatment. We examined the quantitative electroencephalographic (QEEG) cordance biomarker of brain function biomarker in relation to treatment-emergent symptom worsening. METHOD Seventy-two major depressive disorder (MDD) subjects were treated with fluoxetine 20 mg (n = 13), venlafaxine 150 mg (n = 24), or placebo (n = 35) under double-blind conditions. Behavioral ratings determined whether each subject demonstrated worsening of depressed mood, anxiety, or SI during treatment. QEEG cordance data were analyzed to determine whether symptom worsening was associated with neurophysiological changes. RESULTS Antidepressant treatment-emergent SI (13.5%) was associated with a large transient decrease in midline-and-right-frontal (MRF) cordance 48 h after start of medication. CONCLUSION Hypothesis-generating results suggest a pattern of functional changes in midline and right frontal brain regions associated with antidepressant treatment-emergent SI in MDD.
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Affiliation(s)
- A M Hunter
- Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA 90024-1759, USA.
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Pompili M, Serafini G, Innamorati M, Ambrosi E, Giordano G, Girardi P, Tatarelli R, Lester D. Antidepressants and Suicide Risk: A Comprehensive Overview. Pharmaceuticals (Basel) 2010; 3:2861-2883. [PMID: 27713380 PMCID: PMC4034101 DOI: 10.3390/ph3092861] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 08/20/2010] [Accepted: 08/26/2010] [Indexed: 11/17/2022] Open
Abstract
The annual worldwide suicide rate currently averages approximately 13 per 100,000 individuals per year (0.013% per year), with higher average rates for men than for women in all but a few countries, very low rates in children, and relatively high rates in elderly men. Suicide rates vary markedly between countries, reflecting in part differences in case-identification and reporting procedures. Rates of attempted suicide in the general population average 20-30 times higher than rates of completed suicide, but are probably under-reported. Research on the relationship between pharmacotherapy and suicidal behavior was rare until a decade ago. Most ecological studies and large clinical studies have found that a general reduction in suicide rates is significantly correlated with higher rates of prescribing modern antidepressants. However, ecological, cohort and case-control studies and data from brief, randomized, controlled trials in patients with acute affective disorders have found increases, particularly in young patients and particularly for the risk of suicide attempts, as well as increases in suicidal ideation in young patients. whether antidepressants are associated with specific aspects of suicidality (e.g., higher rates of completed suicide, attempted suicide and suicidal ideation) in younger patients with major affective disorders remains a highly controversial question. In light of this gap this paper analyzes research on the relationship between suicidality and antidepressant treatment.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
- McLean Hospital - Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.
| | - Gianluca Serafini
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - Marco Innamorati
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - Elisa Ambrosi
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - Gloria Giordano
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - Roberto Tatarelli
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Via Grottarossa 1037, 00189, Rome, Italy.
| | - David Lester
- The Richard Stockton College of New Jersey, P.O. Box 195 Pomona, NJ 08240, USA.
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West CHK, Ritchie JC, Weiss JM. Paroxetine-induced increase in activity of locus coeruleus neurons in adolescent rats: implication of a countertherapeutic effect of an antidepressant. Neuropsychopharmacology 2010; 35:1653-63. [PMID: 20357759 PMCID: PMC2888691 DOI: 10.1038/npp.2010.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/22/2009] [Accepted: 02/18/2010] [Indexed: 11/08/2022]
Abstract
The concern that antidepressant (AD) drugs, especially selective serotonin reuptake inhibitors and paroxetine (PAR) in particular, can increase suicidality during the early treatment of juvenile patients (children and adolescents) has created a dilemma for clinicians treating depressives. Although preclinical research cannot resolve controversy in this area, our present findings may provide insight into how AD drugs might, under certain conditions, exacerbate rather than ameliorate the depressive state. Both clinical and preclinical evidences indicate that the principal noradrenergic cell group in the brain, the locus coeruleus (LC), is overactive in depressives and that, conversely, effective AD treatments decrease the activity of LC neurons. We report here that short-term (2 and 4 days) administration of PAR produces an increase in the activity of LC neurons (spontaneous firing rate and sensory-evoked responses) in young rats, contrary to the 'therapeutic' decrease in activity typically observed in adult rats. Blood levels of PAR were lower in young rats than in adult rats, although similar low blood levels produced by a lower dose of PAR in adult rats failed to produce an increase in LC activity. In addition, activity of young rats in the swim test was determined to assess depressive-like responses. The same dose/durations of PAR, which produced the largest increases in LC activity in young rats, produced decreases in swim-test activity, indicating that brief administration of PAR in young rats can promote, rather than reduce, the depressive state. These results offer a model that may help screen potential adjunctive treatments to avoid early adverse effects of ADs.
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Fountoulakis KN. The emerging modern face of mood disorders: a didactic editorial with a detailed presentation of data and definitions. Ann Gen Psychiatry 2010; 9:14. [PMID: 20385020 PMCID: PMC2865463 DOI: 10.1186/1744-859x-9-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 04/12/2010] [Indexed: 12/17/2022] Open
Abstract
The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Mood_Disorders.
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Selvaraj V, Veeravalli S, Ramaswamy S, Balon R, Yeragani VK. Depression, suicidality and antidepressants: A coincidence? Indian J Psychiatry 2010; 52:17-20. [PMID: 20174513 PMCID: PMC2824975 DOI: 10.4103/0019-5545.58890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vithyalakshmi Selvaraj
- Department of Psychiatry, Creighton University School of Medicine, Omaha, Nebraska, India
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Clinical correlates of the worsening or emergence of suicidal ideation during SSRI treatment of depression: an examination of citalopram in the STAR*D study. J Affect Disord 2009; 117:63-73. [PMID: 19217668 DOI: 10.1016/j.jad.2009.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 12/27/2008] [Accepted: 01/04/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Untreated major depressive disorder (MDD) is a major risk factor for suicide, but some data suggest antidepressants may be associated with increased suicidal ideation (SI) in some depressed patients. The purpose of this study was to determine whether, and in whom, treatment of MDD is associated with increased or emergent SI. METHODS Patients were treated with Citalopram, 10-60 mg/day for 12-14 weeks. A score >0 on Item 12 of the Quick Inventory of Depressive Symptomatology - Self-Report indicated the presence of SI. Worsening was defined by a >or=1 point increase. Emergent SI was defined by an increase from 0 at baseline to >or=1 during treatment. RESULTS Of the 1909 participants with baseline SI, 57% experienced improvement in SI by their first post-baseline visit and 5% worsened. By the final visit, 74% experienced improvement and 4% worsened. Of 1721 participants without baseline SI, 7% experienced emergence by the first postbaseline visit. Of these, 63% had no SI at their final visit. Major risk factors for treatment-emergent SI at the first treatment visit were drug abuse, severe depression and melancholic features. LIMITATIONS Main limitations are lack of a comparison group to help pinpoint whether citalopram treatment added risk or protection, a placebo group to determine whether changes in SI were related to illness factors, medication effects or other factors, and more detailed and validated measures of SI. CONCLUSIONS SI and behaviors, core features of MDD, wax and wane in intensity before, during, and perhaps after treatment. It is clinically important to understand risk factors, maintain careful surveillance and treat as vigorously as necessary to attain remission.
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Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009; 180:291-7. [PMID: 19188627 DOI: 10.1503/cmaj.081514] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is unclear whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressant drugs reduce the risk of suicide in people with depression. We explored the association between exposure to SSRIs and risk of suicide completion or attempt. METHODS We conducted a systematic review of observational studies that reported completed or attempted suicide in depressed individuals who were exposed to SSRIs compared with those who were not exposed to antidepressants. We assessed the overall risk of completed or attempted suicide. RESULTS Eight studies involving more than 200 000 patients with moderate or severe depression were included in the meta-analysis. Although exposure to SSRIs increased the risk of completed or attempted suicide among adolescents (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.51-2.44), the risk was decreased among adults (OR 0.57, 95% CI 0.47-0.70). Among people aged 65 or more years, exposure to SSRIs had a protective effect (OR 0.46, 95% CI 0.27-0.79). Sensitivity analyses did not change these findings. In particular, for studies that used completed suicide as an outcome, exposure to SSRIs was associated with increased risk among adolescents (OR 5.81, 95% CI 1.57-21.51) and decreased risk among adults (OR 0.66, 95% CI 0.52-0.83) and older people (OR 0.53, 95% CI 0.26-1.06). INTERPRETATION Based on data from observational studies, use of SSRIs may be associated with a reduced risk of suicide in adults with depression. Among adolescents, use of SSRIs may increase suicidality.
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Affiliation(s)
- Corrado Barbui
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
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Castelpietra G, Morsanutto A, Pascolo-Fabrici E, Isacsson G. Antidepressant use and suicide prevention: a prescription database study in the region Friuli Venezia Giulia, Italy. Acta Psychiatr Scand 2008; 118:382-8. [PMID: 18754835 DOI: 10.1111/j.1600-0447.2008.01240.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the possible impact of the increased use of antidepressants on suicide rates in the Italian region of Friuli Venezia Giulia (FVG). METHOD Individual-based data on antidepressants in FVG from 1997 to 2006 were obtained from the regional prescription database, and linked to data on suicide for the same period obtained from the regional health information system. Age and sex were considered. RESULTS The number of users of antidepressants increased almost fivefold during the study period. Selective serotonin reuptake inhibitors accounted for 71% of the individual users in 2006. The number of defined daily doses (DDD) per patient increased almost sevenfold. In parallel, the suicide rate decreased by one-third in men as well as in women, and in subjects under and over the age of 60 years. CONCLUSION Suicide rates in FVG have declined in agreement with the hypothesis that the use of antidepressants may prevent suicide.
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Affiliation(s)
- G Castelpietra
- Department of Clinical, Morphological and Technological Sciences, Division of Psychiatry, University of Trieste, Trieste, Italy
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Tondo L, Lepri B, Baldessarini RJ. Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder. Acta Psychiatr Scand 2008; 118:106-15. [PMID: 18397362 DOI: 10.1111/j.1600-0447.2008.01178.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Relationships between antidepressant treatment and suicidality remain uncertain in major depressive disorder (MDD), and rarely evaluated in bipolar disorder (BPD). METHOD We evaluated changes in suicidality ratings (Hamilton Depression Rating Scale item-3) at the start and after 3.59 +/- 2.57 months of sustained antidepressant treatment in a systematically assessed clinical sample (n = 789) of 605 patients with MDD, 103 patients with BPD-II and 81 patients with BPD-I (based on DSM-IV; 68.1% women; aged 44.3 +/- 16.1 years), comparing suicidal vs. non-suicidal and recovered vs. unrecovered initially suicidal patients. RESULTS Suicidal patients (103/789, 16.5%; BPD/MDD risk: 2.2) were more depressed and were ill longer. During treatment, 81.5% of suicidal patients became non-suicidal; 0.46% of 656 initially non-suicidal patients reported new suicidal thoughts, with no new attempts. Becoming non-suicidal was associated with greater depression severity and greater improvement. CONCLUSION Suicidal ideation was prevalent in patients with depressed major affective disorder, but most of the initially suicidal patients became non-suicidal with antidepressant treatment, independent of diagnosis, treatment type or dose.
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Affiliation(s)
- L Tondo
- Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, MA, USA
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Lader M. Limitations of current medical treatments for depression: disturbed circadian rhythms as a possible therapeutic target. Eur Neuropsychopharmacol 2007; 17:743-55. [PMID: 17624740 DOI: 10.1016/j.euroneuro.2007.05.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 05/16/2007] [Accepted: 05/24/2007] [Indexed: 12/01/2022]
Abstract
The proportion of diagnosed depressives prescribed antidepressants has increased markedly over the last 20 years, mainly following the introduction of the selective serotonin reuptake inhibitors. However, currently available antidepressants have notable limitations, relating to their only moderate efficacy relative to placebo, relatively slow onset of action, possible withdrawal symptoms, and problems of compliance. Sleep disturbances are often used to identify newly presenting depressive patients, and may be part of a more general alteration of bodily rhythms. There are links between pharmacological treatments and circadian rhythms in depression, which might represent another, new option for the development of a therapeutic approach to depression treatment. Many antidepressants affect sleep, some are sedative, and others have been used specifically in severely insomniac depressives. Disturbances in circadian rhythms may be an integral part of depressive mechanisms, and normalising them via an innovative mechanism of antidepressant action may be a fruitful avenue in the search for improved antidepressant agents.
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Affiliation(s)
- Malcolm Lader
- PO Box 56, Institute of Psychiatry, Denmark Hill, London SE5 8AF, United Kingdom.
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Abstract
A growing body of research indicates that sleep disturbances are associated with suicidal ideation and behaviors. This article (1) provides a critical review of the extant literature on sleep and suicidality and (2) addresses shared underlying neurobiological factors, biological and social zeitgebers, treatment implications, and future directions for research. Findings indicate that suicidal ideation and behaviors are closely associated with sleep complaints, and in some cases, this association exists above and beyond depression. Several cross-sectional investigations indicate a unique association between nightmares and suicidal ideation, whereas the relationship between insomnia and suicidality requires further study. Underlying neurobiological factors may, in part, account for the relationship between sleep and suicide. Serotonergic neurotransmission appears to play a critical role in both sleep and suicide. Finally, it remains unclear whether or not sleep-oriented interventions may reduce risk for suicidal behaviors. Unlike other suicide risk factors, sleep complaints may be particularly amenable to treatment. As a warning sign, disturbances in sleep may thus be especially useful to research and may serve as an important clinical target for future suicide intervention efforts.
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Affiliation(s)
- Rebecca A Bernert
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Gonda X, Fountoulakis KN, Kaprinis G, Rihmer Z. Prediction and prevention of suicide in patients with unipolar depression and anxiety. Ann Gen Psychiatry 2007; 6:23. [PMID: 17803824 PMCID: PMC2031887 DOI: 10.1186/1744-859x-6-23] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 09/05/2007] [Indexed: 11/10/2022] Open
Abstract
Epidemiological data suggest that between 59 and 87% of suicide victims suffered from major depression while up to 15% of these patients will eventually commit suicide. Male gender, previous suicide attempt(s), comorbid mental disorders, adverse life-situations, acute psycho-social stressors etc. also constitute robust risk factors. Anxiety and minor depression present with a low to moderate increase in suicide risk but anxiety-depression comorbidity increases this risk dramatically Contrary to the traditional psychoanalytic approach which considers suicide as a retrospective murder or an aggression turned in-wards, more recent studies suggest that the motivations to commit suicide may vary and are often too obscure. Neurobiological data suggest that low brain serotonin activity might play a key role along with the tryptophan hydroxylase gene. Social factors include social support networks, religion etc. It is proven that most suicide victims had asked for professional help just before committing suicide, however they were either not diagnosed (particularly males) or the treatment they received was inappropriate or inadequate. The conclusion is that promoting suicide prevention requires the improving of training and skills of both psychiatrists and many non-psychiatrists and especially GPs in recognizing and treating depression and anxiety. A shift of focus of attention is required in primary care to detect potentially suicidal patients presenting with psychological problems. The proper use of antidepressants, after a careful diagnostic evaluation, is important and recent studies suggest that successful acute and long-term antidepressant pharmacotherapy reduces suicide morbidity and mortality.
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Affiliation(s)
- Xenia Gonda
- Clinical Psychologist, Department of Psychiatry, No. III, National Institute for Psychiatry and Neurology, Budapest, Hungary
| | | | - George Kaprinis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
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Henriksson S, Isacsson G. Increased antidepressant use and fewer suicides in Jämtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatr Scand 2006; 114:159-67. [PMID: 16889586 DOI: 10.1111/j.1600-0447.2006.00822.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To consider and evaluate a continuing medical education programme for general practitioners (GPs) on depression in Jämtland county, Sweden, inspired by the Gotland study. METHOD Interactive seminars were conducted between 1995 and 2002 in Jämtland county. For evaluation, suicide rates and annual sales statistics of antidepressants were compared with national averages. Questionnaires were used for information about attitudes and prescribing habits. RESULTS The suicide rate in Jämtland decreased to the same level as the national average. The use of antidepressants increased from 25% below the Swedish average to the same level. The selective serotonin re-uptake inhibitors (SSRIs) were preferred because of their tolerability. Suicide issues were considered to be most important in the management of depressed patients. CONCLUSION A trend towards a greater prescription of antidepressants and fewer suicides after an educational programme on depression for GPs replicated the findings from the Gotland study. The educational programme will be conducted annually and could be a model for other regions.
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Affiliation(s)
- S Henriksson
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
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Abstract
The effects of antidepressants on suicide are controversial; on the one hand they decrease the incidence of death by suicide, as reflected in epidemiological studies, and on the other hand, there are claims that they increase the risk of impulsivity and suicide. In 1998, primary care physicians in Israel were not allowed to prescribe selective serotonin reuptake inhibitors and in 1999 this prohibition was lifted. We thus evaluated the association between patterns of antidepressant prescribing and the rate of death by suicide in Israel in 1998 compared with that in 2002. Data regarding deaths by suicide were obtained from the Central Bureau of Statistics. Annual rates of antidepressant prescribing were computed from the Intercontinental Marketing Services database. The Intercontinental Marketing Services data covers three out of the four Health Maintenance Organizations in Israel, encompassing 46% of all citizens. Prescribing of all antidepressants increased 2.6-fold between 1998 and 2002. This increase was significantly more pronounced for the selective serotonin reuptake inhibitors. A shift in prescription practices was noted, with a 1.37-fold increase in prescribing by primary care physicians. While the concomitant decrease in overall national rates of completed suicide did not reach significance (17-14 per 100,000), the incidence decreased significantly in men aged 55-74 years (33-22 per 100,000; P=0.029). An overall reduction in suicides, which was significant only in elderly men, was noted in association with increased rates of antidepressant prescription. This study is limited in scope but adds a unique viewpoint related to the possible positive effect of increased antidepressant prescribing in primary care on suicide.
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Affiliation(s)
- Yoram Barak
- Abarbanel Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Søndergård L, Kvist K, Lopez AG, Andersen PK, Kessing LV. Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995-1999. Acta Psychiatr Scand 2006; 114:168-76. [PMID: 16889587 DOI: 10.1111/j.1600-0447.2006.00796.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the temporal changes in suicide rate among patients treated with antidepressants with the change in suicide rate among persons who have not been treated with antidepressants during 1995-1999. METHOD In a historic prospective national pharmacoepidemiological register linkage study by using four Danish registers we included 438,625 patients who had purchased antidepressants, and compared them with 1,199,057 population based control persons. The annual rate of suicide was estimated using Poisson regression analyses. RESULTS The suicide rate decreased for persons treated with antidepressants as well as for persons not treated with antidepressants. The proportion of persons, who committed suicide and who had not been treated with antidepressants decreased. The reduction in suicide rate was more pronounced among persons treated with SSRIs or older antidepressants than among persons not treated with antidepressants. CONCLUSION Several factors contribute to the decreasing suicide rate. The most pronounced decrease in suicide rate was found among persons treated with antidepressants.
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Affiliation(s)
- L Søndergård
- Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
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Möller HJ. Evidence for beneficial effects of antidepressants on suicidality in depressive patients: a systematic review. Eur Arch Psychiatry Clin Neurosci 2006; 256:329-43. [PMID: 16783501 DOI: 10.1007/s00406-006-0650-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 01/23/2006] [Indexed: 10/24/2022]
Abstract
The role of antidepressants in suicide prevention is a major public health question, given the high prevalence of both depression and depression-related suicidality. Therefore all means available should be utilised to clarify the influence of antidepressants on suicidality. This paper gives a comprehensive overview of the positive effects of antidepressants on suicidality. In the first section, principal methodological issues related to suicidology in general as well as to clinical and epidemiological studies that investigate the influence of antidepressants on suicidality are discussed. In the second section, the results of controlled clinical studies on the efficacy of antidepressants in suicidality are presented. The third section reports on the results of other types of studies, especially epidemiological studies. Altogether, there seems to be reasonable evidence from different research approaches that antidepressants are able to reduce suicidal ideation and also suicidal behaviour in depressive patients. While the evidence for the beneficial effect on suicidal ideation comes from randomised control group studies, some of which used a placebo arm, the evidence for the prophylactic effect on suicidal behaviour, especially suicide, was primarily obtained from well-designed epidemiological studies.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
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Brook R, Klap R, Liao D, Wells KB. Mental health care for adults with suicide ideation. Gen Hosp Psychiatry 2006; 28:271-7. [PMID: 16814625 DOI: 10.1016/j.genhosppsych.2006.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/03/2006] [Accepted: 01/04/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate mental health and substance abuse services use for adults with and without suicide ideation. METHOD 2000-2001 follow-up of respondents to a nationally representative survey. Measures include self-reports of suicide ideation, specialty and primary care mental health services use, past year counseling, psychotropic medications and perceived need. RESULTS The percentage of respondents who reported suicide ideation was 3.6%; 74% of them had a probable psychiatric disorder for which effective treatments exist. Nearly half of those with suicide ideation did not perceive a need for care, including some who received care. Of those with suicide ideation and a probable disorder, almost 40% received no treatment. Of those with suicide ideation who perceived a need for alcohol, drug or mental health (ADM) care, almost 40% received no care or inadequate care. In a multivariate model, having a probable psychiatric disorder, perceived need and being white were associated with increased likelihood of treatment use, among persons with suicide ideation. CONCLUSIONS Many adults with suicide ideation do not perceive a need for care or receive treatment in the same year. Even among those perceiving a need for care, many experience difficulties in obtaining it. It is critical to understand barriers to treatments for this high-risk group.
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Affiliation(s)
- Rachel Brook
- Health Services Research Center, Los Angeles, CA 90024, USA
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Abstract
As in many developed countries, the use of antidepressants in Denmark has been substantially increasing during recent years, coinciding with a decreasing suicide rate. We aimed to investigate the relationship between treatment with antidepressants and suicide on individualized data from a nationwide study comprising an observational cohort study with linkage of registers of all prescribed antidepressants and recorded suicides in Denmark during the period 1995-99. A total of 438 625 patients who purchased at least one prescription of antidepressants and 1073 862 individuals from the general population were included in the study. Patients who continued treatment with selective serotonin reuptake inhibitors (SSRIs) (i.e. who purchased SSRIs twice or more) had a decreased rate of suicide compared with patients who purchased SSRIs once only [rate ratio (RR)=0.63; 95% confidence interval (CI)=0.56-0.71]. Furthermore, the rate of suicide decreased consistently with the number of prescriptions. Similarly, among patients treated with newer antidepressants other than SSRIs, the rate of suicide was decreased compared with the rate for patients who purchased other newer antidepressants once only (RR=0.70; 95% CI=0.52-0.94). Continued antidepressant treatment with SSRIs or other newer antidepressants is found to be associated with a reduced risk of suicide.
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Affiliation(s)
- Lars Søndergård
- Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Copenhagen Ø, Denmark.
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Brådvik L, Berglund M. Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharmacotherapy may have different effects on the occurrence and seriousness of suicide attempts. Depress Anxiety 2006; 23:34-41. [PMID: 16315268 DOI: 10.1002/da.20134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective in this article is to assess the relation between long-term treatments of depressive episodes and attempted or completed suicide in patients who had had a severe depression at index admission. A blind record evaluation of 96 suicides with a primary severe depression and matched controls has been performed. Out of those, 57 and 33, respectively, had made suicide attempts. Occurrence of attempt was less common after electroconvulsive therapy (ECT). However, seriousness of suicide attempt appeared to be reduced in those with at least 4 weeks of antidepressant medication compared to no treatment and ECT. The theory of a suicidal syndrome independent of depression seems supported. Continuation treatment after ECT is recommended.
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Affiliation(s)
- Louise Brådvik
- Department of Clinical Medicine, Division of Psychiatry, Lund University Hospital, Lund, Sweden
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Abstract
In this review of the last 5 years' developments in research into depression we focus on recent advances and current controversies. We cover epidemiology and basic science as well as the treatment of depression in adults in all its forms. Depression in , as well as in has been covered in recent Seminars in The Lancet. Depression in adulthood remains a very common and under-treated condition, resulting in a high degree of disability. Increasingly detailed knowledge about impairment of information processing in depression is being supplemented by quantitative studies of the brain processes underlying these impairments. Most patients improve with present treatments. The mechanisms of action of antidepressants are not fully understood; the hypothesis that reversing hippocampal cell loss in depression may be their active principle is a fascinating new development. Moral panic about the claim that antidepressant serotonin reuptake inhibitors cause patients to commit suicide and become addicted to their medication may have disconcerted the public and members of the medical profession. We will try to describe the considerable effort that has gone into collecting evidence to enlighten this debate.
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Affiliation(s)
- Klaus P Ebmeier
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Morningside Park, Edinburgh, UK.
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Rey JM, Martin A. Selective serotonin reuptake inhibitors and suicidality in juveniles: review of the evidence and implications for clinical practice. Child Adolesc Psychiatr Clin N Am 2006; 15:221-37. [PMID: 16321732 DOI: 10.1016/j.chc.2005.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article reviews the existing evidence regarding whether selective serotonin reuptake inhibitors increase suicidal behaviors in children and examines the implications of the findings for clinical practice and research. When balanced against the fact that depression in the young is a serious, recurring condition that produces personal suffering and can lead to suicide, the overall weight of the evidence favors pharmacologic treatment over nontreatment in moderate to severe depression. Nevertheless, the need for careful clinical monitoring of suicidality and attention to behavioral activation, manic switching, and medication compliance or withdrawal are clearly warranted.
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Affiliation(s)
- Joseph M Rey
- University of Sydney, 72/71 Victoria Street, Potts Point, NSW 2011, Australia.
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Sher L, Oquendo MA, Conason AH, Brent DA, Grunebaum MF, Zalsman G, Burke AK, Mann JJ. Clinical features of depressed patients with or without a family history of alcoholism. Acta Psychiatr Scand 2005; 112:266-71. [PMID: 16156833 DOI: 10.1111/j.1600-0447.2005.00591.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare clinical features of depressed subjects without alcoholism but with a family history of alcoholism to a depressed group without alcoholism and without a family history of alcoholism. METHOD Clinical and demographic data of 209 depressed subjects without a history of alcoholism in first-degree relatives and 73 depressed individuals with a history of alcoholism in first-degree relatives were compared. Subjects with a personal history of alcoholism were excluded. RESULTS Depressed subjects with a family history of alcoholism have a significantly higher prevalence of reported childhood physical and sexual abuse and post-traumatic stress disorder (PTSD), make more suicide attempts, and have greater intent to die at the time of their most lethal suicide attempt, compared to depressed subjects without a family history of alcoholism. CONCLUSION Depressed patients with a family history of alcoholism are at greater risk for suicidal behavior and PTSD and may require more careful management.
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Affiliation(s)
- L Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Akiskal HS, Benazzi F. Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states? Psychopathology 2005; 38:273-80. [PMID: 16179814 DOI: 10.1159/000088445] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 05/19/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent transatlantic concern about suicidality in patients receiving antidepressants prompted us to examine the psychopathologic correlates of suicidal ideation occurring in clinically depressed patients. METHODS The study sample, which consisted of 644 consecutive major depressive outpatients, of which 58.0% had bipolar II disorder (BP-II), was systematically interviewed with the SCID, in order to delineate the diagnostic and psychopathologic correlates of suicidal ideation. RESULTS Such ideation, which was present in 49.5% [and favoring BP-II vs. major depressive disorder (MDD)] at an odds ratio (OR) of 1.3 (95% confidence interval = 0.98-1.8), was clinically significantly associated with depressive mixed state (racing/crowded thoughts and psychomotor agitation/activation during index depression), mood lability, decreased self-esteem, anorexia, as well as melancholic and psychotic features. Multiple logistic regression of suicidal ideation versus depressive symptoms and intradepressive excitatory symptoms revealed that decreased self-esteem (OR = 3.3), racing/crowded thoughts (OR = 1.5), and psychomotor agitation/activation (OR = 1.4) were independent and clinically significant correlates of suicidal ideation, irrespective of depression severity. DISCUSSION From a psychopathologic standpoint, suicidality might be conferred by a combination of both the excited (mixed) depressive and agitated (melancholic) clusters. Trait mood lability appears to favor the genesis of these affective clusters. Within the framework of Kraepelinian psychiatry, both clusters represent depressive mixed states. Given that such states are more prevalent in BP-II, our data provide a possible explanation for the greater suicidality in BP-II patients reported in the literature. In light of the higher odds of suicidal ideation in BP-II versus MDD patients, we hypothesize that the higher prevalence of mental and psychomotor activation in BP-II might be one factor among others that favors the greater likelihood of the transition from suicidal ideation to suicidal action in BP-II. Our analyses delineate a mixed depressive substrate at risk for suicidality. To what extent, if any, antidepressant monotherapy might contribute to the genesis of such states and/or suicidality cannot be answered with the methodology of the present study.
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Affiliation(s)
- Hagop S Akiskal
- International Mood Center, University of California at San Diego, Calif. 92161, USA.
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De Baerdemaeker L, Audenaert K, Peremans K. Anaesthesia for patients with mood disorders. Curr Opin Anaesthesiol 2005; 18:333-8. [PMID: 16534359 DOI: 10.1097/01.aco.0000169243.03754.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Treatment of patients with mood disorders has changed over the past few years. It is not always clear how the anaesthesiologist has to incorporate these antidepressants and mood stabilizers in premedication or even how to anticipate any interaction with anaesthetic technique. RECENT FINDINGS The older generation of antidepressants (tricyclic antidepressants, monoamine oxidase inhibitors) is seldom used nowadays. Actually, treatment with selective serotonin-reuptake inhibitors, serotonin noradrenaline-reuptake inhibitors, noradrenaline-reuptake inhibitor, noradrenergic and specific serotonin antidepressants, or noradrenaline- and dopamine-reuptake inhibitors is common practice. Combination with atypical antipsychotics and newer antiepileptics is suggested as an add-on therapy or as monotherapy, while lithium and valproate therapy is still the first choice in bipolar mood stabilization. Electroconvulsive therapy is still used in therapy-resistant forms of depression; however, the anaesthesia technique herein has been increasingly well described in the last years. Electroencephalogram-derived monitoring such as bispectral index (BIS) can be used as a tool to predict seizure duration. Intoxications with these newer agents are not infrequent and deserve specific attention. In particular, serotonin syndrome is a life-threatening condition that requires great care by the anaesthesiologist. The chronic use of antidepressants does affect the anaesthetized patient: hypotension, arrhythmias, changed thermoregulation, altered postoperative pain, differences in surgical stress response and postoperative confusion. However, it is advised to continue these drugs in the perioperative period. SUMMARY Discontinuation of treatment with the new antidepressants in the perioperative period is not advised. Intoxication with the newer drugs appears to be safer. The anaesthesiologist must pay attention to serotonin syndrome. Electroconculsive therapy has gained renewed attention.
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Affiliation(s)
- Luc De Baerdemaeker
- Department of Anaesthesia, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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