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Home » Predictors of Suicidal Behavior in Adolescent Treatment-Resistant Depression

Predictors of Suicidal Behavior in Adolescent Treatment-Resistant Depression

May 1, 2009
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Section editor, Glen Spielmans, PhD

Researchers assessed predictors of suicidal events and non-suicidal self-harm in a group of 334 moderately to severely depressed adolescents (ages 12-18) who had not responded to at least eight weeks of SSRI treatment. Participants were switched to one of four treatments: a different SSRI, venlafaxine, a different SSRI plus cogni- tive-behavior therapy (CBT), or venlafax- ine plus CBT. Initially, the researchers examined suicidal events and non-suicidal self-harm through spontaneous reports from participants. Halfway through the study, because of concerns raised by the FDA about antidepressants and suicidality, researchers switched to using a more sys- tematic method of assessing suicidality and self-harm, asking specific questions about suicidal intent and behavior on a weekly basis. (Not surprisingly, researchers detected that participants reported signifi- cantly more suicidal events (20.9% vs. 8.8%) and non-suicidal self-injury events (17.6% vs. 2.2%) when the more systematic method of evaluating suicidality was utilized.) Generally, there were no significant differ- ences between treatment groups; however, patients whose baseline suicidal ideation was higher than average were significantly more likely to experience a suicidal event on venlafaxine during the study than patients receiving SSRIs (37.2% vs. 23.3%). Regardless of treatment, patients with any of three characteristics – a history of non- suicidal self-injury, severe drug use, or serious family conflict – were more likely to experience suicidal events during the study (Brent DA et al., Am J Psychiatry 2009;166:418-426).

TCPR’s Take: There is a lot going on in this study. Regarding treatment options for adolescents, the study suggests that venlafaxine may be riskier for adolescents than SSRIs, although the numbers are small. What is perhaps more interesting for clinical practice, though, are some of the secondary findings. The study points to three significant factors that should be carefully assessed in adolescent patients: history of suicidal behavior, current drug use, and level of family conflict. The change in the method of evaluating suicidality was also noteworthy. While systematic monitoring revealed a much higher rate of suicidal behavior and of self-harm than did spontaneous report, both methods caught about the same number of serious events (defined as those that led to hospi- talization, or that were life-threatening or disabling). Nevertheless, one of the lessons from this study is: Don’t wait for your patients to volunteer information on suicidal ideation – instead, ask explicitly about this at each visit.

General Psychiatry
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    Issue Date: May 1, 2009
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    Table Of Contents
    Effective Psychiatric Medications for Eating Disorders
    Psychotherapy for Eating Disorders: A Review of the Current Evidence
    Study Investigates Long-Term Course of ADHD
    Tips on Treating Eating Disordered Patients
    Predictors of Suicidal Behavior in Adolescent Treatment-Resistant Depression
    Discontinuing Antipsychotics May Decrease Mortality Risk in Dementia
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