Suicide and antidepressants: risk, benefits and response to treatment

Abstract

The potential prognostic value of suicidal ideation for responses of depressed patients to antidepressant treatment remains unknown.

Our findings appear to represent the first evidence that being suicidal may predict lesser response to antidepressant and mood-stabilizing treatments in depressed unipolar and bipolar affective disorder patients, independent of diagnosis or overall symptomatic severity.

Interest in this topic has been greatly stimulated by recently suggested associations between treatment with serotonin reuptake inhibitor (SRI) antidepressants and increased suicidal ideation, and perhaps suicide attempts, in juveniles with depressive or anxiety disorders.

Several recent reviews of large numbers of placebo-controlled, and case-control clinical studies involving various types of antidepressants among patient-subjects of widely varied ages have found little aggregate evidence of altered rates of suicide or attempts (decreases or increases), even though such events occurred surprisingly often despite efforts to screen acutely suicidal persons from most antidepressant trials.

In contrast to a lack of convincing evidence of either increases or decreases in risks of suicides or life-threatening attempts during antidepressant treatment, several studies of antidepressants, including SRIs, have found that rating scale scores of suicidal ideation decreased along with other depressive symptoms.

An hypothesis has been reported that the brain-derived neurotrophic factor (BDNF) may be related to both suicidality and poor clinical response to antidepressants.

The authors presents a broad oveview on the topic based on unpublished and published meta-analysises as well as new data regarding response to antidepressant by suicidal patients that appear to be innovative in the interantional literature.