Frequency of Provider Contact After FDA Advisory on Risk of Pediatric Suicidality With SSRIs

Morrato, Elaine H.; Libby, Anne M.; Orton, Heather D.; deGruy, Frank V.; Brent, David A.; Allen, Richard R.; Valuck, Robert J.

doi:10.1176/appi.ajp.2007.07010205

Cited by 89 publications

(78 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinicians are likely to prescribe antidepressants, not placebo. Currently in primary care, where most depressed patients are seen, follow-up visits are infrequent [24,25]. Yet meta-analyses of collaborative care trials, indicate an advantage of collaborative care (which usually involves more patient visits) over usual antidepressant treatment; [26,27] however, collaborative care usually involves several elements, not just more frequent visits.…”

Section: Limitationsmentioning

confidence: 99%

Relationship of Number of Clinic Visits to Response during Placebo-Controlled Antidepressant Trials in Late Life Depression

Delucchi¹

2015

J Depress Anxiety

View full text Add to dashboard Cite

Objectives: To determine if the number of clinic visits affects placebo or drug response in antidepressant trials of late life major depression. Method:A previous systematic review of placebo-controlled antidepressant trials in late life depression was updated. Selected trials randomized patients to antidepressant or placebo and included community dwelling patients aged 60 and older, with Major Depressive Disorder. The association of number of visits with response in the placebo and drug groups was examined adjusting for trial duration and the duration-visit interaction. Regressions were also performed to determine if the relationship between number of visits and response differed between treatment groups and to assess if lifetime duration of MDD influenced the visit-response relationship in the placebo group.Results: Thirteen trials with 5028 patients were selected. After controlling for trial duration, number of visits was significantly associated response in the placebo group (χ2=4.69, p=0.03) but not the drug group (χ2=0.38, p=0.54); however, the association of response and number of visits did not differ significantly between the drug and placebo groups. Response rates appeared to increase with more visits in each group. Conclusions:In late life depressed patients response rates increase with more frequent visits during placebo administration. Although this association was not significant in the group receiving antidepressants and clinical management, analysis of the interaction of several variables is limited by the small number of trials and we would be cautious about concluding that number of visits does not contribute to drug response.

show abstract

Section: Limitationsmentioning

confidence: 99%

Relationship of Number of Clinic Visits to Response during Placebo-Controlled Antidepressant Trials in Late Life Depression

Delucchi¹

2015

J Depress Anxiety

View full text Add to dashboard Cite

show abstract

“…After the initial 2004 BBW release, depression diagnosis and antidepressant prescriptions were reduced across all age groups. [56][57][58] Further research has clarified some of the questions raised by the BBW. In a move that was less publicized than the initial BBW, the FDA modified the BBW in 2009 on the basis of further analyses.…”

Section: Antidepressant Bbwmentioning

confidence: 99%

Practical Suicide-Risk Management for the Busy Primary Care Physician

McDowell

Lineberry

Bostwick

2011

Mayo Clinic Proceedings

109

View full text Add to dashboard Cite

Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. Mayo Clin © 2011 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) [3][4][5] These worries are based on population-level effects of the persistent increased unemployment rate due to the severe recession. [3][4][5] Serious thoughts of suicide, plans for suicide, and suicide attempts are surprisingly common in the general population (Table 1). 6 Despite that frequency, death by suicide is still a low base-rate occurrence and impossible to predict accurately. 7,8 Although a relatively uncommon event, suicide has a lifelong and profound effect personally on the families, friends, and physicians of the person committing suicide.In this concise review, we provide a pragmatic and clinically relevant background on suicide risk management for nonpsychiatrists. We will use frequently asked questions based on our clinical experiences and review key principles of depression treatment as they relate to suicide risk management. We will update and synthesize information gained from research into concerns associated with the antidepressant black box warnings (BBWs) for suicidality and highlight their 2009 revisions. 9 We will then close by describing basic principles in identifying those at risk of suicide, assessing them, and devising practical patient management strategies. IMporTAnCE To prIMAry CArETwo practice realities have spurred interventions to improve primary care recognition and treatment of depression as a public health suicide prevention strategy. 10,11 First, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. 10 A review of studies analyzing this clinical scenario estimated 45% of those dying by suicide saw their primary care physician in the month before their death. 10 Only 20% saw a mental health professional 10 in the preceding month. Women and older patients are more likely to have sought care in the month before suicide 10 than men and younger patients. Second, generalists (internists, pediatricians, family physicians) write most antidepressant prescriptions (62%) in the United States. 11 When...

show abstract

“…Although controversially discussed (Gibbons, 2007;Jureidini, 2007;Olfson and Shaffer, 2007), there is evidence of a parallel increase of suicide rates in the United States and the Netherlands between 2003 and 2005 for the first time in a decade. The intended effect of the FDA warning to improve supervision of patients treated with antidepressants has not yet occurred (Morrato et al, 2008). Moreover, the decline in treating major depression continued, without compensation by substitute care (Libby et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Genome-Wide Association Study of Antidepressant Treatment-Emergent Suicidal Ideation

Menke

Domschke

Klengel

et al. 2011

Neuropsychopharmacol

View full text Add to dashboard Cite

Emergence of suicidal ideation (TESI) during treatment with antidepressants in major depression led to a black box warning. We performed a genome-wide association study to identify genetic markers, which increase the risk for this serious side effect. TESI was evaluated in depressed in-patients (N ¼ 397) and defined by an emergence of suicidal thoughts during hospitalization without suicidal thoughts at admission using the suicide item (3) of the Hamilton Depression Rating Scale. Genotype distribution of 405.383 singlenucleotide polymorphisms (SNPs) in patients with TESI (N ¼ 32/8.1%) was compared to patients without increase in suicidal ideation (N ¼ 329/82.9%) and to a subgroup never reported suicidal ideation (N ¼ 79/19.9%). Top results were analyzed in an independent sample (N ¼ 501). None variant reached genome-wide significance, the best associated SNP was rs1630535 (p-value ¼ 1.3 Â 10 À7 ). The top 79 SNPs could be analyzed in an independent sample, and 14 variants showed nominal significant association with the same risk allele in the replication sample. A discriminant analysis classifying patients using these 79 SNPs revealed a 91% probability to classify TESI vs non-TESI cases correctly in the replication sample. Although our data need to be interpreted carefully owing to the small numbers in both cohorts, they suggest that a combination of genetic markers might indeed be used to identify patients at risk for TESI.

show abstract

Frequency of Provider Contact After FDA Advisory on Risk of Pediatric Suicidality With SSRIs

Abstract: Contrary to expectations, the frequency of visits by patients with new episodes of depression treated with antidepressants did not increase after the October 2003 FDA advisory was issued.

Cited by 89 publications

References 16 publications

Relationship of Number of Clinic Visits to Response during Placebo-Controlled Antidepressant Trials in Late Life Depression

Relationship of Number of Clinic Visits to Response during Placebo-Controlled Antidepressant Trials in Late Life Depression

Practical Suicide-Risk Management for the Busy Primary Care Physician

Genome-Wide Association Study of Antidepressant Treatment-Emergent Suicidal Ideation

Contact Info

Product

Resources

About