History of suicide attempts among patients with depression in the GENDEP project.
BACKGROUND
It has been proposed that a history of suicide attempts could be a correlate of severe depressive disorder and that suicide attempters (SA) could represent a particular subtype of subjects suffering from major depressive disorder. We investigated clinical and demographic characteristics associated with SA and tested the hypothesis that a history of suicide attempts predicts poor response to antidepressants.


METHODS
One-hundred-and-forty-one SA and 670 non-SA subjects with major depressive disorder (MDD) were treated for twelve weeks with escitalopram or nortriptyline in GENDEP, a part-randomized multi-center clinical and pharmacogenetic study. Baseline characteristics were compared using linear and logistic regression. Linear mixed models were used to analyse continuous outcomes during the twelve weeks of follow-up.


RESULTS
At baseline, SA subjects suffered from more severe depression (mean Montgomery-Asberg Depression Rating Scale: 30.29 (7.61) vs 28.43 (6.54), p=0.0002), reported higher level of suicidal ideation (1.21 (0.82) vs 0.73 (0.48), p<0.0001), had a younger age of onset and experienced more depressive episodes, had higher harm avoidance scores and poorer socio-demographic environment than non-SA individuals. However, during the twelve weeks of treatment and after adjustment for baseline severity of depression there was no difference in treatment response between SA and non-SA.


CONCLUSIONS
Due to its retrospective design, it is possible that more severely depressed subjects might report more suicide attempts than less depressed individuals.


CONCLUSIONS
While SA differed from non-SA in several clinical and demographic characteristics, the antidepressants were similarly effective in SA as in comparably severely depressed subjects without a history of suicide attempts.
Perroud
Nader
N
MRC SGDP Centre, Institute of Psychiatry at King's College London, SE5 8AF, London, United Kingdom. nader.perroud@hcuge.ch
Uher
Rudolf
R
Hauser
Joanna
J
Rietschel
Marcella
M
Henigsberg
Neven
N
Placentino
Anna
A
Kozel
Dejan
D
Maier
Wolfgang
W
Mors
Ole
O
Souery
Daniel
D
Dmitrzak-Weglarz
Monika
M
Jorgensen
Lisbeth
L
Kovacic
Zrnka
Z
Giovannini
Caterina
C
Mendlewicz
Julien
J
Zobel
Astrid
A
Strohmaier
Jana
J
McGuffin
Peter
P
Aitchison
Katherine J
KJ
Farmer
Anne
A
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use; D010552:Personality Assessment; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D009661:Nortriptyline