Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

被引:12
作者
Olgiati, Paolo [1 ]
Serretti, Alessandro [1 ]
机构
[1] Univ Bologna, Dept Biomed & Neuromotor Sci, Viale Carlo Pepoli 5, I-40123 Bologna, Italy
关键词
antidepressant response; insomnia; major depressive disorder; remission; suicidal ideation; SEROTONIN REUPTAKE INHIBITORS; STATISTICAL POWER ANALYSIS; BRIEF SELF-REPORT; BIPOLAR-II; SUBTHRESHOLD BIPOLARITY; COMBINING MEDICATIONS; UNIPOLAR DEPRESSION; TRACKING SCALE; MIXED FEATURES; RISK;
D O I
10.1097/YIC.0000000000000416
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Suicidal ideation (SI) is common in major depressive disorder (MDD), and it is a risk factor for suicidal behaviour. Antidepressants are effective in reducing SI, but in some subjects, SI may persist for weeks. This study aimed to disentangle the contribution of baseline clinical characteristics in SI nonremission at week 6. Research involved 198 outpatients with MDD and SI collected within the Combining Medications to Enhance Depression Outcomes trial and treated with different antidepressant combinations. Although SI decreased from baseline to week 6 (P < 0.0001), 78 patients (39%) failed to achieve SI remission. Insomnia [OR, 0.72; 95% confidence interval (CI), 0.52-0.99], reduced need for sleep (OR, 0.75; 95% CI, 0.58-0.99), self-confidence (OR, 0.52; 95% CI, 0.32-0.82), cheerfulness (OR, 0.57; 95% CI, 0.33-0.98), and comorbid panic disorder (OR, 0.93; 95% CI, 0.87-0.99) at baseline were associated with lack of SI remission after controlling for baseline depression and SI scores. The combination of baseline SI and insomnia was moderately effective in predicting the lack of SI remission, with a specificity of 80% (95% CI, 72-87%) and an NPV of 68% (95% CI, 63-72%). In individuals with MDD and SI, the presence of insomnia and bipolar features should prompt a search for more effective treatment solutions in order to favour SI remission and prevent suicidal behaviour.
引用
收藏
页码:193 / 200
页数:8
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