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

Abstract

Objective: The emergence of new drugs for managing suicidal ideation (e.g. ketamine) raises the question of whether suicidal depression (i.e. moderate to severe depression with concomitant suicidal ideation) is a specific depression phenotype. Therefore, this study characterized patients with suicidal depression (baseline clinical characteristics, suicidal ideation and depression evolutions, suicide risk) in two large cohorts of outpatients with depression. Methods: LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with depression (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria), treated and followed up for 6 weeks. Depression severity was assessed with the Hospital Anxiety and Depression Scale, and suicidal ideation with the suicidal item of the Montgomery–Åsberg Depression Rating Scale. Patients with moderate or severe depression (Hospital Anxiety and Depression Scale–Depression subscale score >11) were selected and classified as without suicidal ideation (suicidal item of the Montgomery–Åsberg Depression Rating Scale <2), with moderate suicidal ideation (suicidal item of the Montgomery–Åsberg Depression Rating Scale [2; 3]) and with severe suicidal ideation (suicidal item of the Montgomery–Åsberg Depression Rating Scale ⩾4). Results: Baseline clinical features were more severe (e.g. higher anxiety and depression scores) in depressed patients with moderate/severe suicidal ideation. Depression remission after treatment was less frequent among patients with severe suicidal ideation. The risk of suicide attempt during the follow-up was threefold higher in patients with suicidal ideation among those 10% had persistent suicidal ideation. Conclusion: Suicidal depression could be a specific depression phenotype with more severe clinical characteristics, less frequent depression remission, suicidal ideation persistence and higher suicide attempt risk, despite antidepressant treatment. It seems that novel therapeutic strategies could be needed.

Characterization of suicidal depression: A 1 year prospective study

“…Indeed, patients with suicidal depression have more severe baseline clinical features, respond less well to antidepressants, may have a different clinical course (e.g., depression remission) and have higher suicidal risk than depressed patients without SI [21][22][23][24][25]. We previously reported similar results in a study on two large cohorts of outpatients with unipolar depression [24].…”

Association Between the A118G Polymorphism of the OPRM1 Gene and Suicidal Depression in a Large Cohort of Outpatients with Depression

“…8 Growing evidence suggests that suicidal depression (ie, depression with SI) could be a specific phenotype of depression. Compared with depressed patients without SI, suicidal depressed patients are characterized by more severe clinical features (eg, greater depressive symptom severity and number of depressive episodes, more frequent history of SA) [9][10][11] and worse response to antidepressant treatment. They are also less likely to achieve remission.…”

“…16 Indeed, depressive symptomatology profiles are different in patients with and without SI. 10,17,18 The opioid system might be involved in SB physiopathology. 19 It has been shown that consumption of opiate analgesics is higher in patients with suicidal depression than in those without suicidal depression and in healthy controls, independently of their health status.…”

“…37 We recently showed that suicidal depressed patients were different from non-suicidal patients in this cohort (eg, more severe clinical features, different course of depression and less response to treatment). 10 Thus, we decided to assess whether the A118G SNP was associated with the phenotype of suicidal depression. Indeed, considering our precedent results, we hypothesized that patients with a AA genotype could be more prone to have a suicidal depression.…”

“… 16 Indeed, depressive symptomatology profiles are different in patients with and without SI. 10 , 17 , 18 …”