Antidepressant Dosage and Suicidal Ideation

Abstract

The respondents used 61 distinct EMR systems (Q4) and came from a broad range of practice types (Q1). Nine EMRs were used by 20 or more respondents, accounted for 324 (78.8%) of all users, and users of each of these lost free time (P < .05 for all). Of these 9, the Veterans Affairs' Computer Patient Record System (CPRS) was associated with the least free time loss (−20 minutes) (P = .04). Respondents were experienced EMR users. Most (70.6%) used all of the EMR functions listed in Q4, and 82.5% had EMRs in their practice for more than a year (Q7). Among all respondents, 89.8% reported that at least 1 data management function was slower post-EMR adoption, and 63.9% reported that note writing took longer. Surprisingly, a third (33.9%) reported that it took longer to find and review medical record data with the EMR than without, and a similar proportion, 32.2%, that it was slower to read other clinicians' notes.The mean time loss for attending physicians was −48 minutes per clinic day (P < .001), or 4 hours per 5-day clinic week. The mean loss for trainees was −18 minutes per day, less than that of attending physicians (P < .001). For the 59.4% of all respondents who did lose time, the mean loss was −78 minutes per clinic day, or 6.5 hours per 5-day clinic week.

Antidepressant prescription rates and suicide attempt rates from 2004 to 2016 in a nationally representative sample of adolescents in the USA

“…This is an important finding because temporality is a necessary but not sufficient prerequisite for causality (Hill, 1965). Additional research has revealed that the antidepressant-suicidality association is most likely dose-dependent (Courtet et al 2014; Miller et al 2014), which is another key aspect of causality (Hill, 1965).…”

Suicidal Depressed Patients Respond Less Well to Antidepressants in the Short Term

“…They also emphasize the need for specific strategies in depressed suicidal patients, especially if they have active suicidal thoughts or have already made an SA. For instance, we know that an excessive dosage of antidepressants at the beginning of treatment is associated with an increased risk of SI and SAs [51,52] and that some new pharmacological strategies show promising results against suicide risk. [53] Indeed, "suicidal behavior disorder" appeared in the "Conditions for Further Study" of the DSM-5, to promote further research on its validity at the clinical, pathophysiological, and therapeutic levels.…”

Characteristics and treatment outcome of suicidal depression: Two large naturalistic cohorts of depressed outpatients

“…These cohorts were created to study depression and SB. This study is not a post hoc analysis from another study (Courtet et al, 2014;Voegeli et al, 2016). Participants were recruited by general practitioners or psychiatrists at primary and psychiatric care clinical centers throughout France.…”