Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder

Trine Madsen; Henriette N. Buttenschøn; Rudolf Uher; Ida Behrendt-Møller; Nader Perroud; Wolfgang Maier; Joanna Hauser; Mojca Zvezdana Dernovsek; Neven Henigsberg; Daniel Souery; Marcella Rietschel; Peter McGuffin; Katherine J. Aitchison; Ole Mors; Ole Köhler-Forsberg

doi:10.4088/JCP.18m12575

Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder

Trine Madsen, Henriette N. Buttenschøn, Rudolf Uher, Ida Behrendt-Møller, Nader Perroud, Wolfgang Maier, Joanna Hauser, Mojca Zvezdana Dernovsek, Neven Henigsberg, Daniel Souery, Marcella Rietschel, Peter McGuffin, Katherine J. Aitchison, Ole Mors, Ole Köhler-Forsberg

Medicine

Résultat de recherche: Article › examen par les pairs

11 Citations (Scopus)

Résumé

Background: Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation. Methods: Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors. Results: We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response. Conclusion: Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.

Langue d'origine	English
Numéro d'article	18m12575
Journal	Journal of Clinical Psychiatry
Volume	80
Numéro de publication	4
DOI	https://doi.org/10.4088/JCP.18m12575
Statut de publication	Published - 2019

Note bibliographique

Funding Information:
Submitted: September 14, 2018; accepted February 6, 2019. Published online: July 16, 2019. Potential conflicts of interest: Dr Uher is supported by the Canada Research Chairs Program (file number 950-225925). Dr Aitchison holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta; has been a member of various advisory boards; has received consultancy fees and honoraria; and has received research grants from various companies including Johnson & Johnson Pharmaceutical Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. Dr Henigsberg has participated in clinical trials sponsored by Lundbeck, Takeda, GlaxoSmithKline, and Pfizer. Dr Souery has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. Dr McGuffin has received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline. The other authors report no financial relationships with commercial interests. Funding/support: The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK). Role of the sponsor: The funders had no role in the design and conduct of the study; in data collection, analysis, or interpretation; or in writing the report. Supplementary material: Available at PSYCHIATRIST.COM.

Funding Information:
The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK).

Publisher Copyright:
© 2019 Copyright Physicians Postgraduate Press, Inc.

ASJC Scopus Subject Areas

Psychiatry and Mental health

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

Accès au document

10.4088/JCP.18m12575

Autres fichiers et liens

Citer

Madsen, T., Buttenschøn, H. N., Uher, R., Behrendt-Møller, I., Perroud, N., Maier, W., Hauser, J., Dernovsek, M. Z., Henigsberg, N., Souery, D., Rietschel, M., McGuffin, P., Aitchison, K. J., Mors, O., & Köhler-Forsberg, O. (2019). Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder. Journal of Clinical Psychiatry, 80(4), Article 18m12575. https://doi.org/10.4088/JCP.18m12575

Madsen, T, Buttenschøn, HN, Uher, R, Behrendt-Møller, I, Perroud, N, Maier, W, Hauser, J, Dernovsek, MZ, Henigsberg, N, Souery, D, Rietschel, M, McGuffin, P, Aitchison, KJ, Mors, O & Köhler-Forsberg, O 2019, 'Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder', Journal of Clinical Psychiatry, vol. 80, n° 4, 18m12575. https://doi.org/10.4088/JCP.18m12575

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title = "Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder",

abstract = "Background: Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation. Methods: Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors. Results: We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response. Conclusion: Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.",

author = "Trine Madsen and Buttensch{\o}n, {Henriette N.} and Rudolf Uher and Ida Behrendt-M{\o}ller and Nader Perroud and Wolfgang Maier and Joanna Hauser and Dernovsek, {Mojca Zvezdana} and Neven Henigsberg and Daniel Souery and Marcella Rietschel and Peter McGuffin and Aitchison, {Katherine J.} and Ole Mors and Ole K{\"o}hler-Forsberg",

note = "Funding Information: Submitted: September 14, 2018; accepted February 6, 2019. Published online: July 16, 2019. Potential conflicts of interest: Dr Uher is supported by the Canada Research Chairs Program (file number 950-225925). Dr Aitchison holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta; has been a member of various advisory boards; has received consultancy fees and honoraria; and has received research grants from various companies including Johnson & Johnson Pharmaceutical Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. Dr Henigsberg has participated in clinical trials sponsored by Lundbeck, Takeda, GlaxoSmithKline, and Pfizer. Dr Souery has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. Dr McGuffin has received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline. The other authors report no financial relationships with commercial interests. Funding/support: The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King{\textquoteright}s College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK). Role of the sponsor: The funders had no role in the design and conduct of the study; in data collection, analysis, or interpretation; or in writing the report. Supplementary material: Available at PSYCHIATRIST.COM. Funding Information: The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK). Publisher Copyright: {\textcopyright} 2019 Copyright Physicians Postgraduate Press, Inc.",

year = "2019",

doi = "10.4088/JCP.18m12575",

language = "English",

volume = "80",

journal = "Journal of Clinical Psychiatry",

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TY - JOUR

T1 - Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder

AU - Madsen, Trine

AU - Buttenschøn, Henriette N.

AU - Uher, Rudolf

AU - Behrendt-Møller, Ida

AU - Perroud, Nader

AU - Maier, Wolfgang

AU - Hauser, Joanna

AU - Dernovsek, Mojca Zvezdana

AU - Henigsberg, Neven

AU - Souery, Daniel

AU - Rietschel, Marcella

AU - McGuffin, Peter

AU - Aitchison, Katherine J.

AU - Mors, Ole

AU - Köhler-Forsberg, Ole

N1 - Funding Information: Submitted: September 14, 2018; accepted February 6, 2019. Published online: July 16, 2019. Potential conflicts of interest: Dr Uher is supported by the Canada Research Chairs Program (file number 950-225925). Dr Aitchison holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta; has been a member of various advisory boards; has received consultancy fees and honoraria; and has received research grants from various companies including Johnson & Johnson Pharmaceutical Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. Dr Henigsberg has participated in clinical trials sponsored by Lundbeck, Takeda, GlaxoSmithKline, and Pfizer. Dr Souery has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. Dr McGuffin has received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline. The other authors report no financial relationships with commercial interests. Funding/support: The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK). Role of the sponsor: The funders had no role in the design and conduct of the study; in data collection, analysis, or interpretation; or in writing the report. Supplementary material: Available at PSYCHIATRIST.COM. Funding Information: The Genome-Based Therapeutic Drugs for Depression (GENDEP) study was funded by a European Commission Framework 6 grant (EC Contract Ref LSHB-CT-2003-503428). Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. In its latter stages, GENDEP received additional funding at the Institute of Psychiatry site from the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London and South London, and Maudsley NHS Foundation Trust (awarded by the National Institute for Health Research, Department of Health, UK). Publisher Copyright: © 2019 Copyright Physicians Postgraduate Press, Inc.

PY - 2019

Y1 - 2019

N2 - Background: Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation. Methods: Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors. Results: We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response. Conclusion: Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.

AB - Background: Suicidal ideation is a frequent and difficult-to-treat clinical challenge among patients with major depressive disorder (MDD). However, little is known regarding the differential development during antidepressant treatment and whether some patients may suffer from persistent suicidal ideation. Methods: Among 811 patients with Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-verified MDD from 2004-2007 assessed weekly for 12 weeks of escitalopram or nortriptyline antidepressant treatment, we applied item response theory to integrate a suicidality score based on 3 rating scales. We performed latent growth mixture modeling analysis to empirically identify trajectories. Multinomial logistic regression analyses estimated associations with potential predictors. Results: We identified 5 distinct classes of suicidal ideation. The Persistent-low class (53.7%) showed no suicidal ideation whereas the Persistent-high class (9.8%) had high suicidal ideation throughout 12 weeks. Two classes showed a fluctuating course: the Fluctuating class (5.2%) ended at a low level of suicidal ideation, whereas the Slow-response-relapse class (4.8%) initially responded slowly but then experienced a large increase to a high level of suicidal ideation after 12 weeks. The Fast-response class (26.5%) had a high baseline severity similar to the Persistent-high class but responded quickly within a few weeks and remained at a low level. Previous suicide attempts and higher mood symptom severity were associated with worse suicidal ideation trajectories, whereas living with a partner showed a trend toward better response. Conclusion: Approximately 1 of 5 patients with MDD showed high or fluctuating suicidal ideation despite antidepressant treatment. Studies should investigate whether suicidal ideation may persist for longer periods and more targeted treatment possibilities.

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Trajectories of suicidal ideation during 12 weeks of escitalopram or nortriptyline antidepressant treatment among 811 patients with major depressive disorder

Résumé

Note bibliographique

ASJC Scopus Subject Areas

ODD de l’ONU

Accès au document

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