Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence and impact on treatment outcome.
Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact of suicidal ideation and hopelessness on treatment with nortriptyline (NT). The degree of suicidal ideation and hopelessness was assessed during the screen visit with the use of items #3 and #30 of the Hamilton Depression Rating Scale (HAM-D) in 89 patients with TRD who entered a 6-week open trial of NT. Forty of these patients also completed the Beck Hopelessness Index (BHI) during the screen visit. In separate logistic regressions, the scores from the BHI and the two HAM-D items were then tested as predictors of clinical response to the 6-week trial with NT, controlling for the severity of depression. More than half of patients reported thoughts or wishes of death to self and significant hopelessness. A greater degree of hopelessness before treatment in completers, reflected by the score on the HAM-D item #30, predicted response to NT. More than half of patients with prominent hopelessness who completed the trial responded. Patients with TRD are more likely than not to report prominent suicidal ideation and hopelessness. Furthermore, a full 6-week trial of NT, a relatively noradrenergic tricyclic antidepressant, may be particularly useful in patients who have failed to respond to several antidepressants and also report significant hopelessness.
Papakostas
George I
GI
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, WACC 812, 15 Parkman Street, Boston, Massachusetts, 02114, USA.
Petersen
Timothy
T
Pava
Joel
J
Masson
Ella
E
Worthington
John J
JJ
Alpert
Jonathan E
JE
Fava
Maruizio
M
Nierenberg
Andrew A
AA
D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D000368:Aged; D000553:Ambulatory Care; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D008094:Lithium; D009661:Nortriptyline