Emergence, persistence, and resolution of suicidal ideation during treatment of depression in old age.
BACKGROUND
To determine the rate and clinical correlates of emergent, persistent, and resolved suicidal ideation during treatment of major depression in the elderly.


METHODS
Based on the course of suicidal ideation before and during 12 weeks of antidepressant treatment, we classified 437 elderly patients (234 treated with paroxetine; 203 with nortriptyline) as either non-suicidal or as having "emergent", "persistent", or "resolved" suicidality. We compared the four groups on pretreatment demographic and clinical measures and with respect to depression, anxiety, and akathisia during treatment.


RESULTS
Rates of emergent, persistent, and resolved suicidality were 7.8%, 12.6%, and 15.6%, respectively. Patients with persistent suicidal ideation were more likely to have recurrent depression than non-suicidal patients or patients whose suicidality resolved with treatment. At the start of treatment, patients in all three suicidal groups had lower self-esteem than non-suicidal patients. During the course of treatment, emergent suicidality was not associated with akathisia, nor did rates of emergent suicidality differ between paroxetine- and nortriptyline-treated patients. While at baseline the levels of depression and anxiety and agitation were similar in the four groups, patients with resolved suicidality had a favorable treatment response, while patients with emergent and persistent suicidality were more likely to maintain higher depression scores and had higher levels of anxiety and agitation during treatment.


CONCLUSIONS
Emergence of suicidal ideation is not common but is clinically significant during treatment of late-life depression and may signal more difficult-to-treat-depression.
Szanto
Katalin
K
University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania 15213, United States. szantok@upmc.edu
Mulsant
Benoit H
BH
Houck
Patricia R
PR
Dew
Mary Amanda
MA
Dombrovski
Alexandre
A
Pollock
Bruce G
BG
Reynolds
Charles F
CF
D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety; D003863:Depression / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000523:psychology; D011595:Psychomotor Agitation; D012008:Recurrence; D012565:Schizophrenic Psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D000092864:Suicide Prevention
D000928:Antidepressive Agents