Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry

Abstract Objectives Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors. Materials and Methods This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors. Results For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain. Conclusion Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.

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Barbiturate Anticonvulsants as a Cause of Severe Depression

PEDIATRICS ◽

10.1542/peds.82.2.284 ◽

1988 ◽

Vol 82 (2) ◽

pp. 284-284

Author(s):

GABOR BARABAS ◽

WENDY S. MATTHEWS

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Severe Depression ◽

Recent Issue ◽

Major Depressive ◽

Seizure Disorders ◽

Emotional Factors ◽

Psychiatric Disturbances ◽

Epileptic Children

To the Editor.— In a recent issue, Brent et al1 compared patients treated with phenobarbital with those treated with carbamazepine for seizure disorders. They noted that there was a much higher prevalence of major depressive disorder and suicidal ideation among those taking phenobarbital. They emphasized that the incidence of psychiatric disturbances is higher among epileptic children as compared with controls and that on occasion this may be due to iatrogenic effects of anticonvulsants and not only to factors intrinsic to epilepsy or secondary emotional factors.

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Escitalopram Versus SNRI Antidepressants in the Acute Treatment of Major Depressive Disorder: Integrative Analysis of Four Double-Blind, Randomized Clinical Trials

CNS Spectrums ◽

10.1017/s1092852900020320 ◽

2009 ◽

Vol 14 (6) ◽

pp. 326-333 ◽

Cited By ~ 19

Author(s):

Susan G. Kornstein ◽

Dayong Li ◽

Yongcai Mao ◽

Sara Larsson ◽

Henning F. Andersen ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Randomized Clinical Trials ◽

Rating Scale ◽

Severe Depression ◽

Major Depressive ◽

Double Blind ◽

Madrs Score ◽

Treatment Difference

AbstractIntroduction: Recent data suggest that escitalopram may be more effective in severe depression than other selective serotonin reuptake inhibitors.Methods: Individual patient data from four randomized, double-blind comparative trials of escitalopram versus a serotonin/norepinephrine reuptake inhibitor (SNRI) (two trials with duloxetine and two with venlafaxine extended release) in outpatients (18–85 years of age) with moderate-to-severe major depressive disorder were pooled. The primary efficacy parameter in all four trials was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score.Results: Significantly fewer escitalopram (82/524) than SNRI (114/527) patients prematurely withdrew from treatment due to all causes (15.6% vs. 21.6%, Fisher Exact: P=.014) and adverse events (5.3% vs. 12.0%, Fisher Exact: P <.0001). Mean reduction in MADRS score from baseline to Week 8 was significantly greater for the escitalopram group versus the SNRI group using the last observation carried forward (LOCF) approach [mean treatment difference at Week 8 of 1.7 points (P <.01)]. Similar results were observed in the severely depressed (baseline MADRS score ≥30) patient subset (mean treatment difference at Week 8 of 2.9 points [P <.001, LOCF]). Observed cases analyses yielded no significant differences in efficacy parameters.Conclusion: This pooled analysis indicates that escitalopram is at least as effective as the SNRIs (venlafaxine XR and duloxetine), even in severe depression, and escitalopram treatment was better tolerated.

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Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

Psychological Medicine ◽

10.1017/s0033291718002568 ◽

2018 ◽

Vol 49 (11) ◽

pp. 1869-1878 ◽

Cited By ~ 3

Author(s):

Boadie W. Dunlop ◽

Philip E. Polychroniou ◽

Jeffrey J. Rakofsky ◽

Charles B. Nemeroff ◽

W. Edward Craighead ◽

...

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Rating Scale ◽

Antidepressant Medication ◽

Major Depressive ◽

Residual Symptom ◽

Residual Symptoms ◽

Antidepressant Medications ◽

Item Scores

AbstractBackgroundPersisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.MethodsThree hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.ResultsAmong treatment completers (n= 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%;p= .001). Among patients who terminated the trial early (n= 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.ConclusionsDepressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.

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Is There a Delay in the Onset of the Antidepressant Effect of Electroconvulsive Therapy?

The British Journal of Psychiatry ◽

10.1192/bjp.164.1.106 ◽

1994 ◽

Vol 164 (1) ◽

pp. 106-109 ◽

Cited By ~ 18

Author(s):

Colin R. Rodger ◽

Allan I. F. Scott ◽

Lawrence J. Whalley

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Antidepressant Effect ◽

Major Depressive ◽

Depressed Patients ◽

Severity Of Depression ◽

Drug Free ◽

Hamilton Rating Scale

The severity of depression in 11 drug-free unipolar patients diagnosed with definite major depressive disorder was assessed using the Hamilton Rating Scale for Depression during a course (5–10 treatments) of bilateral electroconvulsive therapy (ECT). The degree of improvement after three treatments of ECT was six times greater than the improvement that occurred over the remainder of the course. Although depressed patients who recover with ECT require repeated treatments, the treatments early in a course of ECT can have marked antidepressant effect.

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A prospective study to compare the efficacy of vilazodone and escitalopram tablets in the treatment of patients with newly diagnosed major depressive disorder

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20201753 ◽

2020 ◽

Vol 9 (5) ◽

pp. 757

Author(s):

Arjun Adiyodi ◽

C. V. Singh ◽

A. K. Mishra ◽

Alok Dixit ◽

Virendra Singh

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Rating Scale ◽

Therapy Group ◽

Age Group ◽

Newly Diagnosed ◽

Major Depressive ◽

Treatment Groups ◽

Severity Of Depression ◽

A Prospective Study

Background: With the availability of large number of anti-depressant drugs, a thorough knowledge of comparative efficacy of the commonly used antidepressants is necessary to prescribe best drug molecule to the patient. This improves the compliance and therapeutic outcome. The aim of the study is to compare the efficacy of vilazodone and escitalopram in the treatment of patients with newly diagnosed major depressive disorder in a prospective study.Methods: 200 patients attending the psychiatry out-patient department diagnosed with major depressive disorder were assessed and enrolled into vilazodone 40 mg and escitalopram 20 mg treatment groups. Hamilton depression rating scale score (HDRS) was used to assess the severity of depression disorder at regular intervals.Results: Maximum cases were in the 21-30 age group and minimum cases in above 60 years age group. Males contributed maximum to number of depression cases with respect to females in both the treatment groups. Both escitalopram and vilazodone therapy group showed onset of improvement at the end of 1st week. The efficacy of both treatment arms in reducing HDRS is comparable till 2nd week of treatment, but at 6th month vilazodone was more efficacious than escitalopram therapy. Conclusions: Escitalopram tablet given once/twice daily is significantly effective in reducing HDRS score as early as 2nd week. At 6th month vilazodone tablet was more efficacious than escitalopram therapy. Vilazodone is safe with fewer adverse effects as compared to escitalopram.

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A prospective study of major depressive disorder among COVID 19 survivors at a tertiary care hospital

Archives of Mental Health ◽

10.4103/amh.amh_72_20 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Parveen Kumar ◽

Kajalpreet Kaur ◽

VishalKanaiyalal Patel ◽

DishaAlkeshbhai Vasavada ◽

LubnaMohammedrafik Nerli ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Prospective Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Major Depressive ◽

A Prospective Study

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Altered serum interleukin-7 and interleukin-10 are associated with drug-free major depressive disorder

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320916655 ◽

2020 ◽

Vol 10 ◽

pp. 204512532091665 ◽

Cited By ~ 3

Author(s):

Sadia Anjum ◽

M. M. A. Shalahuddin Qusar ◽

Mohammad Shahriar ◽

Sardar Mohammad Ashraful Islam ◽

Mohiuddin Ahmed Bhuiyan ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Inflammatory Process ◽

Rating Scale ◽

Interleukin 10 ◽

Enzyme Linked Immunosorbent Assay ◽

Major Depressive ◽

Interleukin 7 ◽

Cytokine Levels ◽

Severity Of Depression

Background: Abnormal expression of inflammatory cytokines in major depressive disorder (MDD) suggests the activation of an inflammatory process. The pattern of alterations in cytokine levels is still ambiguous. The present study aimed to evaluate interleukin-7 (IL-7) and interleukin-10 (IL-10) for their involvement in the pathophysiology of MDD and determine their relationships with depression risk. Methods: The study included 166 medication-free subjects: 84 MDD patients and 82 sex- and age-matched healthy controls (HCs). A qualified psychiatrist diagnosed patients and evaluated controls based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Hamilton depression rating scale (Ham-D) was used to measure the severity of depression in MDD patients. Serum IL-7 and IL-10 levels were measured using enzyme-linked immunosorbent assay (ELISA) kits. Results: Compared with HCs, the serum levels of IL-7 were significantly decreased, whereas that of IL-10 increased in MDD patients. Moreover, the severity of depression is correlated with the altered levels of IL-7 and IL-10 in MDD patients. We found a negative correlation between IL-7 and Hamilton depression rating (Ham-D) scores ( r = –0.580, p < 0.05), whereas there was a positive correlation between IL-10 and Ham-D scores ( r = 0.555, p < 0.05). Conclusions: The altered levels of serum IL-7 and IL-10 in MDD patients may represent a homeostatic mechanism that enhances the inflammatory process during depression. The alterations of these cytokine levels in MDD and their association with the severity of depression support them as promising, but there may still be controversial factors for understanding the pathophysiology of depression.

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Measures of suicidality in phase 3 clinical trials of levomilnacipran ER in adults with major depressive disorder

CNS Spectrums ◽

10.1017/s1092852916000663 ◽

2017 ◽

Vol 22 (6) ◽

pp. 475-483 ◽

Cited By ~ 2

Author(s):

Michael E. Thase ◽

Carl Gommoll ◽

Changzheng Chen ◽

Kenneth Kramer ◽

Arif Khan ◽

...

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Rating Scale ◽

Short Term ◽

Open Label ◽

Major Depressive ◽

Double Blind ◽

And Behavior

ObjectiveTo evaluate the effects of levomilnacipran extended-release (ER) on suicidal ideation and behavior in adults with major depressive disorder (MDD).MethodsPost hoc analyses were conducted in patients from 4 randomized, double-blind, placebo-controlled trials and a long-term, open-label extension study of levomilnacipran ER (40-120 mg/d) in adults with MDD. Analyses included incidence of suicide-related treatment-emergent adverse events (TEAEs); incidence of Columbia–Suicide Severity Rating Scale (C-SSRS) suicidal ideation (score=1–5) and behavior (score=6-10); percent of patients who shifted from no C-SSRS suicidal ideation/behavior at baseline to suicidal ideation during treatment (worsened from score=0 to score=1–5), or vice-versa (improved from score=1-5 to score=0).ResultsSuicide-related TEAEs occurred in<1% of patients in the levomilnacipran ER studies. The incidence of C-SSRS suicidal ideation was 22.2%, 23.9%, and 21.7% for placebo, short-term levomilnacipran ER, and long-term levomilnacipran ER, respectively; C-SSRS suicidal behavior was<1% in all of these groups. In the short-term studies, the percentage of patients with C-SSRS shifts were as follows: worsening from score=0 to score=1–5 (placebo, 8.6%; levomilnacipran ER, 11.0%); improvement from score=1–5 to score=0 (placebo, 24.0%; levomilnacipran ER, 27.7%).ConclusionIn adult MDD patients, the incidence of suicidal ideation and behavior was similar between placebo and short-term levomilnacipran ER as indicated by TEAE reports and C-SSRS scores. Worsening in C-SSRS scores was also similar between placebo and levomilnacipran ER. There was no indication of increased suicidality during longer courses of continued therapy. Together, these findings suggest that this medication is not associated with increased risks of suicidal ideation or behavior.

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