title: Fluoxetine increases suicide ideation less than placebo during treatment of adults with minor depressive disorder.
abstract: OBJECTIVE
  Some reports suggest an increase in suicide ideations and behaviors in patients treated with antidepressants. This is an analysis of the impact of fluoxetine on suicide ideations in outpatients with minor depressive disorder.
  
  
  METHODS
  Research subjects were adult outpatients with minor depressive disorder (N = 162), who received fluoxetine or placebo in a prospective, 12-week, double-blind randomized trial. The research participants were evaluated weekly with standard rating scales that included four suicide-related items: item 3 of the Hamilton Rating Scale for Depression (HRSD), item 18 of Inventory of Depressive Symptomatology (IDS-C), and items 15 and 59 of the Hopkins Symptom Checklist (SCL-90). Clinically significant intensification of suicide ideation was defined as an increase of ≥2 points on any of these items.
  
  
  RESULTS
  Overall 60/162 subjects (37%) had an increase of ≥1 point during treatment and 17/162 (10.5%) of ≥2 points on at least one suicide item, with 12/81 (14.8%) placebo and 5/81 (6.2%) fluoxetine-treated subjects having a ≥2 point gain. Of the study participants with baseline suicide ideation, 9/22 (40.9%) placebo and 3/24 (12.5%) fluoxetine treated had ≥2 point increase (p = 0.04). Survival analysis revealed that subjects on placebo were significantly more likely (p = 0.050) to experience a ≥2 point increase on one or more item, a difference that emerged early and continued throughout the 12-week trial.
  
  
  CONCLUSIONS
  Compared to placebo, fluoxetine was not associated with a clinically significant increase in suicide ideation among adults with minor depressive disorder during 12 weeks of treatment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. sgarlow@emory.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Garlow
authors.forename: Becky
authors.initials: B
authors.lastname: Kinkead
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Judd
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schettler
authors.forename: Mark Hyman
authors.initials: MH
authors.lastname: Rapaport
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000627:therapeutic use; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D059020:Suicidal Ideation; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D010919:Placebos; D005473:Fluoxetine
keywords: Antidepressant; Fluoxetine; Minor depressive disorder; Treatment emergent suicide ideation