Differences in antipsychotic treatment between depressive patients with and without a suicide attempt

Marie Asp,Livia Ambrus,Margareta Reis,Sofie Manninen,Johan Fernström,Daniel Lindqvist,Åsa Westrin

doi:10.1016/j.comppsych.2021.152264

Marie Asp, Livia Ambrus + Show 5 more

Open Access

https://doi.org/10.1016/j.comppsych.2021.152264

Copy DOI

Abstract

BackgroundDepressed suicide attempters are, according to some earlier studies, treated more often with antipsychotics than depressive non-suicide attempters. Cluster B personality disorders, especially borderline personality disorder, are associated with a high suicide risk, and antipsychotics are commonly used for the reduction of symptoms. However, no previous study has taken comorbid personality disorders into account when assessing the use of antipsychotics in patients with unipolar depression. Therefore, the aim of this study was to investigate the clinical selection of pharmacotherapy in unipolar depression with and without a previous suicide attempt, taking into account potential confounders such as cluster B personality disorders. MethodsThe study sample consisted of 247 patients with unipolar depression. The study was approved by the Regional Ethical Review Board in Lund, Sweden. Study participants were recruited from 4 different secondary psychiatric care clinics in Sweden and were diagnosed according to the DSM-IV-TR with the MINI and SCID II. Previous and ongoing psychiatric treatments were investigated in detail and medical records were assessed. ResultsThirty percent of the patients had made previous suicide attempts. Depressed suicide attempters underwent both lifetime treatment with antipsychotics and an ongoing antipsychotic treatment significantly more often than non-attempters. Significances remained after a regression analysis, adjusting for cluster B personality disorders, symptom severity, age at the onset of depression, and lifetime psychotic symptoms. ConclusionsThis is the first study to consider the effect of comorbidity with cluster B personality disorders when comparing treatment of depressive suicide and non-suicide attempters.Our findings suggest that suicide attempters are more frequently treated with antipsychotics compared to non-suicide attempters, regardless of cluster B personality disorder comorbidity. These findings are important for clinicians to consider and would also be relevant to future studies evaluating reduction of suicide risk with antipsychotics in patients with psychiatric comorbidity and a history of attempted suicide.

Highlights

The majority of suicide worldwide is assumed to be associated with depression, and approximately one-third of all depressed patients attempt suicide at some point in their lives [1]
One strategy for depressive patients who do not respond to the first line of treatment is augmentation with second-generation antipsychotics (SGAs) [5,6,7,8]; there is some preliminary evidence that SGAs reduce suicidal behavior in patients with depression [9]
Suicide attempters were significantly younger at the time of their first depressive episode (p < 0.05); had more current depressive symp toms, measured as total MADRS score (p < 0.05); and experienced the lifetime presence of psychotic symptoms significantly more often (p < 0.05)

Summary

Introduction

The majority of suicide worldwide is assumed to be associated with depression, and approximately one-third of all depressed patients attempt suicide at some point in their lives [1]. The aim of this study was to investigate the clinical selection of pharmacotherapy in unipolar depression with and without a previous suicide attempt, taking into account potential confounders such as cluster B personality disorders. Conclusions: This is the first study to consider the effect of comorbidity with cluster B personality disorders when comparing treatment of depressive suicide and non-suicide attempters. Our findings suggest that suicide attempters are more frequently treated with antipsychotics compared to nonsuicide attempters, regardless of cluster B personality disorder comorbidity. These findings are important for clinicians to consider and would be relevant to future studies evaluating reduction of suicide risk with antipsychotics in patients with psychiatric comorbidity and a history of attempted suicide

Objectives

Methods

Results

Discussion

Conclusion