title: Time Course and Predictors of Suicidal Ideation During Citalopram Treatment in the STAR*D Trial.
abstract: OBJECTIVE
  Selective serotonin reuptake inhibitors are first-line treatment for major depressive disorder (MDD), but their impact on suicidal ideation is equivocal. Our goal is to examine the time course and clinical predictors of citalopram-induced suicidal ideation during phase 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.
  
  
  METHODS
  Of the 4,041 subjects with DSM-IV nonpsychotic MDD in the STAR*D trial phase 1 (2001-2006), we included in our analysis 3,577 subjects who reported side-effect data and had received citalopram (20-60 mg/d) for 8-14 weeks. Suicidal ideation was reported on item 12 of the Quick Inventory of Depressive Symptomatology, Self-Report. Survival analysis and receiver operating characteristic analysis were used to assess baseline characteristics associated with emergence and worsening of suicidal ideation.
  
  
  RESULTS
  Suicidal ideation was more likely to occur early in citalopram treatment, with few subjects showing emergence or worsening occurring after 6 weeks of treatment. Clinical variables explained very little of the variance in worsening or emergence of suicidal ideation with citalopram treatment (generalized R² ≤ 2% in survival analysis). Being Hispanic, taking sedative medications, increased depression severity, absence of hypersomnia, and cardiac comorbidity were significantly (P ≤ .04) associated with greater likelihood of emergence of suicidal ideation in patients without suicidal ideation at baseline. Being widowed, better work performance, weight loss at baseline, and the presence of vascular or neurologic comorbidities were associated with a greater likelihood of worsening of suicidal ideation.
  
  
  CONCLUSIONS
  Baseline clinical variables were poor predictors of emergence or worsening of suicidal ideation. As such, increased research focusing on clinical correlates rather than clinical predictors of suicidal ideation may be useful, as intervening events may be crucial in bringing about increased suicidality.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00021528.
authors.affiliation: Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Coughlin
authors.affiliation: Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Jakubovski
authors.affiliation: Child Study Center, Yale University School of Medicine, PO Box 2070900, New Haven, CT 06520. michael.bloch@yale.edu.|Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA.|Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
mesh_terms: D000328:Adult; D015283:Citalopram / Q000009:adverse effects* / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D012307:Risk Factors; D059020:Suicidal Ideation; D013997:Time Factors
chemical_list: D015283:Citalopram