Response to intravenous antidepressant treatment by suicidal vs. nonsuicidal depressed patients

Abstract

Background As effects of suicidal status on antidepressant responses remain uncertain, we compared responses to treatment in suicidal and nonsuicidal depressed patients. Methods We evaluated treatment response and covariates in 82 depressed patients diagnosed with DSM-IV major depressive ( n = 50) or bipolar disorders ( n = 32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment, using citalopram given intravenously and then orally, with or without a mood-stabilizer. Suicidal status was based on an intake score of ≥ 3 on item-3 of the 17-item Hamilton Depression Rating Scale, verified by clinical assessment. Morbidity and clinical change were assessed with the remaining 16 items (HDRS 16). Results Suicidal ( n = 31) and nonsuicidal subjects ( n = 51) were similar in baseline ratings of depressive symptom-severity but were depressed longer and more likely to abuse substances. Suicidal ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS 16) improved half as much as in nonsuicidal subjects (13.4 vs. 25.1 points), independent of diagnosis, initial illness-severity, and treatment, and half as many patients improved by ≥ 20%. In multivariate modeling, only being suicidal predicted poor response. Conclusions Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.