One in five people with depression have suicidal thoughts despite treatment with antidepressants. This is shown by a new study from iPSYCH. The results can be used to examine whether more targeted treatment could be provided for patients where medication does not have a sufficient effect.
Antidepressants are used in particular against moderate to severe depressions. A new study from the Danish national research project iPSYCH shows that twenty percent of people with depression have suicidal thoughts, even though they are treated with antidepressants.
"Suicidal thoughts are a major challenge among patients with depression," explains PhD Trine Madsen, from the Capital Region of Denmark, Mental Health Services, who is the lead author on the study.
The researchers studied 811 patients who had moderate to severe depression and were treated with two different antidepressants over a twelve week period. Weekly measurements were taken of the level of suicidal thoughts.
"We were able to place the patients in five categories based on how their suicidal thoughts developed during the treatment," says Trine Madsen.
Slightly more than half of the patients experienced no or low levels of suicidal thoughts during the twelve weeks of treatment, while one in four had suicidal thoughts at the beginning of the study but responded well to the medicine already after a few weeks.
The remaining twenty percent of patients could be further categorised, with ten percent experiencing an increased level of suicidal thoughts throughout the whole study, and ten percent who experienced shifts between higher and lower levels of suicidal thoughts.
The results have just been published in the scientific journal 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. 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. The results can be used to provide more targeted treatment for those patients where the medicine does not have a sufficient effect," explains MD and PhD Ole Köhler-Forsberg from Aarhus University and Aarhus University Hospital Psychiatry, who is the last author on the study.
The researchers indicate that future studies should investigate whether patients may experience suicidal thoughts for even longer than the twelve week period over which the current study extended.
"Some studies have suggested that people with mental disorders can have suicidal thoughts for a number of years. In addition, there should be studies of whether more intensive treatment involving increased pharmacological and/or psychological treatment may lead to a better response in patients who don't respond to the medicine within the first few weeks," says Ole Köhler-Forsberg.
Background for the results:
The study is a part-randomized clinical study.
The study was conducted in collaboration with Dalhousie University, Halifax, Canada, and King's College, London, UK.
The scientific article Trajectories of Suicidal Ideation During 12 Weeks of Escitalopram or Nortriptyline Antidepressant Treatment Among 811 Patients With Major Depressive Disorder is published in the Journal of Clinical Psychiatry.
PhD Trine Madsen
Capital Region of Denmark, Mental Health Services
Tel.: (+45) 3029 1319
MD, PhD Ole Köhler-Forsberg
Aarhus University, Department of Clinical Medicine and
Aarhus University Hospital Psychiatry, Psychosis Research Unit
Tel.: (+45) 2342 0661