Suicidal Depressed Patients Respond Less Well to Antidepressants in the Short Term

López-Castromán, Jorge; Jaussent, Isabelle; Gorwood, Philip; Courtet, Philippe

doi:10.1002/da.22473

Cited by 48 publications

(30 citation statements)

References 66 publications

(75 reference statements)

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“…Our findings suggest a vicious circle in which more vulnerable patients (those more severely depressed, having more suicidal thoughts and pain) are less adherent to medication, which could worsen the clinical picture maintaining, in turn, low adherence. In this sense, it has been reported that antidepressant treatment seems to be less effective among depressed patients presenting suicidal ideation (i.e., thus more severely ill), compared to those depressed without suicidal thoughts (Lopez‐Castroman, Jaussent, Gorwood, & Courtet, ). Probably adherence to treatment, which was not explored in this study, could help to understand these findings.…”

Section: Discussionmentioning

confidence: 99%

Determinants of suboptimal medication adherence in patients with a major depressive episode

et al. 2018

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Background Major Depression (MD) is often a chronic condition requiring a long‐term pharmacologic treatment. Despite the efficacy of antidepressants, the medication adherence in those affected is usually very poor. In this scenario, further research concerning drivers of suboptimal adherence is needed. We aimed to explore medication adherence in patients with a MD episode, and to identify sociodemographic, clinical (psychiatric antecedents, comorbidities, medication, pain, and medication side effects), and psychosocial factors (negative life events, childhood trauma, and attitudes to medication) related to adherence status. Method The Medication Adherence Rating Scale (MARS) was completed by 370 patients at hospital admission. Participants were divided into groups of optimal and suboptimal adherence based on the medication adherence behavior score (MARS's factor 1), and were compared with respect to the study variables. Results Twenty‐nine percent of participants (n = 107) were found to be optimally adherents to their medication (score = 4/4). Compared to optimally adherents, suboptimally adherents (71%) presented a significantly higher depression severity, more psychiatric hospitalizations, suicidal ideation, physical pain, negative medication side effects, and antecedents of emotional maltreatment. Suboptimally adherents also had less favorable attitudes toward medication and were less in a relationship than optimally adherents. Multivariate analyses showed that depression severity, suicidal ideation, and physical pain increase the probability of belonging to the suboptimal adherent group. Conclusion These results suggest a vicious circle in which more vulnerable patients are less adherent to medication, which could worsen the clinical picture maintaining, in turn, low adherence. More efforts are needed to develop interventions aiming to improve medication adherence in MD patients.

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Section: Discussionmentioning

confidence: 99%

Determinants of suboptimal medication adherence in patients with a major depressive episode

et al. 2018

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“…In our study, all anxiety scales were associated with suicidal ideation. Suicidality itself has been noted in some studies as a predictor of poor short-term treatment response (Lopez-Castroman, Jaussent, Gorwood, & Courtet, 2016;Szanto, Mulsant, Houck, Dew, & Reynolds, 2003). For instance, Szanto et al (2003) showed that older depressed patients with high levels of suicidality both had a long time to respond and were less likely to fully respond to treatment.…”

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confidence: 99%

Comorbid anxiety in late‐life depression: Relationship with remission and suicidal ideation on venlafaxine treatment

et al. 2019

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Objective: The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). Method: In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission.We also examined the relationships between anxiety scores and suicidality at baseline.Results: Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality.Conclusion: In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission. K E Y W O R D S antidepressants, anxiety/anxiety disorders, depression, geriatric/aging/elderly, suicide/self-harm Institute of Mental Health (R01 MH083660 and P30 MH90333 to University of Pittsburgh, R01 MH083648 to Washington University, and R01 MH083643 to University of Toronto).

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“…Third, one cannot exclude that ACT improved the severity of suicidal ideation through improvements in depression. Should that be the case, it might still represent a worthwhile path to reducing suicidal ideation, given that antidepressants have been shown to be less effective in suicidal patients [57]. Fourth, given the number of comparisons being performed on secondary outcomes, the risk of chance findings may be increased.…”

Section: Discussionmentioning

confidence: 99%

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial

Ducasse

Jaussent

Arpon-Brand

et al. 2018

Psychother Psychosom

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Background: The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. Methods: We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. Results: Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = –1.88 [0.34] vs. –0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. Conclusions: Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.

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Suicidal Depressed Patients Respond Less Well to Antidepressants in the Short Term

Abstract: Antidepressant treatment seems to be less effective among those patients that need it most. Clinical trials including suicidal patients are needed to investigate specific treatment options.

Cited by 48 publications

References 66 publications

Determinants of suboptimal medication adherence in patients with a major depressive episode

Determinants of suboptimal medication adherence in patients with a major depressive episode

Comorbid anxiety in late‐life depression: Relationship with remission and suicidal ideation on venlafaxine treatment

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial

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