Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

Mittal, Vikrant; Brown, W. L.; Shorter, Edward

doi:10.1176/appi.ps.60.3.384

Cited by 4 publications

(9 citation statements)

References 6 publications

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“…7,10 However, a systematic review from 2009 showed that the research that has been carried out contradicts this belief, 21 and our review also suggests that it is wrong. We found that antidepressants double the risk of suicidality and violence, and it is particularly interesting that the volunteers in the studies we reviewed were healthy adults with no signs of a mental disorder.…”

Section: Discussionmentioning

confidence: 67%

Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers

2016

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Objective: To quantify the risk of suicidality and violence when selective serotonin and serotonin-norepinephrine reuptake inhibitors are given to adult healthy volunteers with no signs of a mental disorder. Design: Systematic review and meta-analysis. Main outcome measure: Harms related to suicidality, hostility, activation events, psychotic events and mood disturbances. Setting: Published trials identified by searching PubMed and Embase and clinical study reports obtained from the European and UK drug regulators. Participants: Double-blind, placebo-controlled trials in adult healthy volunteers that reported on suicidality or violence or precursor events to suicidality or violence. Results: A total of 5787 publications were screened and 130 trials fulfilled our inclusion criteria. The trials were generally uninformative; 97 trials did not report the randomisation method, 75 trials did not report any discontinuations and 63 trials did not report any adverse events or lack thereof. Eleven of the 130 published trials and two of 29 clinical study reports we received from the regulatory agencies presented data for our meta-analysis. Treatment of adult healthy volunteers with antidepressants doubled their risk of harms related to suicidality and violence, odds ratio 1.85 (95% confidence interval 1.11 to 3.08, p ¼ 0.02, I2 ¼ 18%). The number needed to treat to harm one healthy person was 16 (95% confidence interval 8 to 100; Mantel-Haenszel risk difference 0.06). There can be little doubt that we underestimated the harms of antidepressants, as we only had access to the published articles for 11 of our 13 trials. Conclusions: Antidepressants double the occurrence of events in adult healthy volunteers that can lead to suicide and violence.

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Section: Discussionmentioning

confidence: 67%

Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers

2016

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“…Schweizer et al, 1988; Mittal et al, 2009), thus, when it is likely that someone has restored some psychic and physic resources, that may allow one to effectively deliberate, in contrast to those phases when one cannot even perform the simplest tasks of daily life. Moreover, one may doubt, whether this example really can account for an intact practical sense, albeit an “I can” is involved.…”

Section: The Depressive Situation – Changes Of Practical Sense and Mementioning

confidence: 99%

The depressive situation

Jacobs¹

2013

Front. Psychol.

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From a naturalistic perspective on mental illness, depression is often described in terms of biological dysfunctions, while a normative perspective emphasizes the lived experience of depression as a harmful condition. The paper relates a conceptual analysis of “depressive situation” to an analysis of the lived experience of depression. As such, it predominantly aims to specify depression as a harmful condition in lights of normative perspective on mental disorder, but partially refers to empirical research, i.e., naturalistic perspective on depression, to exemplarily stress on the methodological merits and limits of relating phenomenological considerations closer to empirical research. The depressive situation is further specified with an examination of the evaluative dynamics by which individuals meaningfully relate to themselves, others and the world. These evaluative dynamics emerge out of the interplay of pre-reflective and reflective processes, which are significantly altered in depression. Such alterations of the evaluative structure are inextricably intertwined with significant distortions of practical sense in depression. From a phenomenological perspective, these distortions of practical sense show in characteristic experiences of evaluative incoherence and impairments of agency. Finally, this paper focuses on an examination of “evaluative incapacity,” which has the integrative potential to capture a range of typical changes of meaningful relatedness that determine the depressive situation.

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“…Furthermore, Mittal et al [7] claimed that improvement in depression may be accompanied by an increase in suicidal ideation. Few empirical studies are available regarding the temporal association between depression symptoms and suicidal ideation.…”

Section: Introductionmentioning

confidence: 99%

“…We define trajectories as longitudinal records of symptom severities that form progression patterns. Additionally, most available data regarding temporal associations between suicidal ideation and other symptoms of depression are derived from clinical trials rather than patients treated in community practices [7–9].…”

Section: Introductionmentioning

confidence: 99%

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Machine learning discovery of longitudinal patterns of depression and suicidal ideation

2019

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Background and aimDepression is often accompanied by thoughts of self-harm, which are a strong predictor of subsequent suicide attempt and suicide death. Few empirical data are available regarding the temporal correlation between depression symptoms and suicidal ideation. We investigated the anecdotal concern that suicidal ideation may increase during a period of depression improvement.DataLongitudinal Patient Health Questionnaire (PHQ)-9 is a questionnaire of 9 multiple-choice questions to assess the frequency of depressive symptoms within the previous two weeks. We analyzed a chronic depression treatment population’s electronic health record (EHR) data, containing 610 patients’ longitudinal PHQ-9 scores (62% age 45 and older; 68% female) within 40 weeks.MethodsThe irregular and sparse EHR data were transformed into continuous trajectories using Gaussian process regression. We first estimated the correlations between the symptoms (total score of the first 8 questions; PHQ-8) and suicide ideation (9th question score; Item 9) using the cross-correlation function. We then used an artificial neural network (ANN) to discover subtypes of depression patterns from the fitted depression trajectories. In addition, we conducted a separate analysis using the unfitted raw PHQ scores to examine PHQ-8’s and Item 9’s pattern changes.ResultsResults showed that the majority of patients’ PHQ-8 and Item 9 scores displayed strong temporal correlations. We found five patterns in the PHQ-8 and the Item 9 trajectories. We also found 8% - 13% of the patients have experienced an increase in suicidal ideation during the improvement of their PHQ-8. Using a trajectory-based method for subtype pattern detection in depression progression, we provided a better understanding of temporal correlations between depression symptoms over time.

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Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

Cited by 4 publications

References 6 publications

Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers

Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers

The depressive situation

Machine learning discovery of longitudinal patterns of depression and suicidal ideation

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