Suicide‐related events among child and adolescent patients during short‐term antidepressant therapy

Abstract

Aims: Antidepressants have been of limited use for adolescent subjects with depression because of druginduced suicide-related events (SRE). Therefore, we investigated actual suicidality and its risk factors during antidepressant therapy among child and adolescent patients in clinical settings. Methods:The risks of SRE, consisting of suicidal ideation, self-mutilation and suicide attempt, were prospectively monitored among 70 child and adolescent patients (15.4 Ϯ 2.8 years) during the first 3 months of antidepressant therapy.Results: The proportion of SRE decreased from 47.1% to 22.9% after the treatment. Subjects with persistent risks of SRE were significantly characterized by female sex (P < 0.05), psychotic features (P < 0.001), borderline personality disorder (P < 0.01), previous SRE (P < 0.001), and such baseline psychopathology as anhedonia (P < 0.005), irritability (P < 0.005) and hopelessness (P < 0.001). Discriminant analysis showed that baseline severity of SRE, borderline personality disorder and psychotic features were closely associated with SRE during antidepressant therapy. Total scoring using those three pretreatment factors predicted risks of SRE with sufficient sensitivity (81%)/specificity (98%) as well as high positive likelihood ratio (43.9).Conclusions: These findings suggest that deteriorated risk of SRE in child and adolescent patients receiving antidepressants should not be overestimated while some pretreatment characteristics may be useful to predict the outcome of SRE after antidepressant therapy.

A short-term longitudinal examination of the relations between depression, anhedonia, and self-injurious thoughts and behaviors in adults with a history of self-injury

“…Beyond loss of physical energy and sexual activity, loss of interest and loss of pleasure are incrementally predictive of greater suicidal ideation (Winer et al, 2014a). Even research examining the effect of antidepressants found that pre-treatment anhedonia predicted risk of suicide-related events at treatment termination (Kuba et al, 2011). …”

Anhedonia: A Concept Analysis

“…One study found significant levels of anhedonia in 37% of people with depression and 45% of people with schizophrenia (Pelizza & Ferrari, 2009). Other conditions linked to anhedonia include substance dependence (Martinotti et al, 2011; Rose et al, 2012), anxiety (Dinovo & Vasey, 2011), suicide related events (Kuba et al, 2011), post-traumatic stress disorder (Pittman, Goldsmith, Lemmer, Kilmer, & Baker, 2012; Wechsler-Zimring & Kearney, 2011), autism (Chevallier, Grezes, Molesworth, Berthoz, & Happe, 2012), Parkinson’s disease (Fujiwara et al, 2011; Miura et al, 2012), stroke (Sibon, Lassalle-Lagadec, Renou, & Swendsen, 2012), and some chronic medical conditions (de Cock, Emons, Nefs, Pop, & Pouwer, 2011; Nefs, Pouwer, Pop, & Denollet, 2012; Pelle et al, 2011; P. J. Tully & Baker, 2012).…”

A naturalistic study of suicidal adolescents treated with an SSRI: Suicidal ideation and behavior during 3-month post-hospitalization period

“…Along similar lines, one other study found that pre-treatment patient characteristics largely accounted for increased suicidality (Kuba et al 2011), while others have stated that the studies which formed the basis of the FDA regulatory decision were limited due to the exclusion of suicidal adolescents in clinical trials (Antonuccio 2008, Jureidini and McHenry 2009)…”