Response to intravenous antidepressant treatment by suicidal vs. nonsuicidal depressed patients.
BACKGROUND
As effects of suicidal status on antidepressant responses remain uncertain, we compared responses to treatment in suicidal and nonsuicidal depressed patients.


METHODS
We evaluated treatment response and covariates in 82 depressed patients diagnosed with DSM-IV major depressive (n=50) or bipolar disorders (n=32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment, using citalopram given intravenously and then orally, with or without a mood-stabilizer. Suicidal status was based on an intake score of > or = 3 on item-3 of the 17-item Hamilton Depression Rating Scale, verified by clinical assessment. Morbidity and clinical change were assessed with the remaining 16 items (HDRS(16)).


RESULTS
Suicidal (n=31) and nonsuicidal subjects (n=51) were similar in baseline ratings of depressive symptom-severity but were depressed longer and more likely to abuse substances. Suicidal ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS(16)) improved half as much as in nonsuicidal subjects (13.4 vs. 25.1 points), independent of diagnosis, initial illness-severity, and treatment, and half as many patients improved by > or = 20%. In multivariate modeling, only being suicidal predicted poor response.


CONCLUSIONS
Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.
Pompili
Maurizio
M
Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. maurizio.pompili@uniroma1.it
Baldessarini
Ross J
RJ
Tondo
Leonardo
L
Innamorati
Marco
M
Tatarelli
Roberto
R
Girardi
Paolo
P
De Pisa
Eleonora
E
D000284:Administration, Oral; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D015283:Citalopram / Q000008:administration & dosage* / Q000009:adverse effects; D015897:Comorbidity; D003631:Day Care, Medical; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D055502:Secondary Prevention; D013405:Suicide / Q000523:psychology; D055815:Young Adult; D000092864:Suicide Prevention
D018687:Antidepressive Agents, Second-Generation; D018692:Antimanic Agents; D015283:Citalopram