Approximately 20% of people with major depressive disorder (MDD) experienced high or fluctuating suicidal ideation over 12 weeks of treatment with antidepressants, researchers found in a study published in The Journal of Clinical Psychiatry.
“It’s surprising that such a large number of people with depression experience suicidal thoughts over such a long time,” said researcher Ole Köhler-Forsberg, MD, PhD, of Aarhus University and Aarhus University Hospital in Denmark.
The study team investigated suicidal ideation among 811 patients with MDD over 12 weeks of treatment with escitalopram or nortriptyline. Patients were assessed weekly.
Many patients (53.7%) experienced no or low levels of suicidal thoughts over the course of the study. Another 26.5% had high levels of suicidal ideation at the study’s start but responded quickly to treatment and stayed at a low level of suicidal ideation throughout the remainder of the study.
However, nearly 10% of patients had high suicidal ideation throughout the study, and another 10% showed shifts between lower and higher levels of suicidal thoughts throughout the 12 weeks.
“We also found that previous suicide attempts and the severity of the depression were associated with a higher level of suicidal thoughts and the persistence of these thoughts,” Dr. Köhler-Forsberg said. “The results can be used to provide more targeted treatment for those patients where the medicine does not have a sufficient effect.”
Researchers recommended future studies look into whether suicidal ideation may persist for longer than 12 weeks in vulnerable patients and whether more intensive treatment could yield a better response.
Madsen T, Buttenschøn HN, Uher R, et al. Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder. The Journal of Clinical Psychiatry. 2019;80(4):18m12575.