Presence of suicidal ideation as a prognostic indicator
Mood Disorders Program, Regional Mental Health Care, London. 850 Highbury Ave North, London, ON N6A 4H1, Canada
Mood Disorders Program, Regional Mental Health Care, London. 850 Highbury Ave North, London, ON N6A 4H1
|How to cite this article:|
Sharma V. Presence of suicidal ideation as a prognostic indicator.J Postgrad Med 2004;50:187-188
|How to cite this URL:|
Sharma V. Presence of suicidal ideation as a prognostic indicator. J Postgrad Med [serial online] 2004 [cited 2020 Jan 17 ];50:187-188
Available from: http://www.jpgmonline.com/text.asp?2004/50/3/187/12600
Depression is one of the most common mental disorders seen in primary care settings. Major depression, a chronic and recurrent illness that is associated with considerable mortality and morbidity continues to pose challenges for early detection and appropriate management. The enormity of the problem could be understood by the assessment provided by the World Health Organization Global Burden of Disease Study, which estimated that in terms of magnitude of suffering, depression would rank second only to ischaemic heart disease by the year 2020. Major depression is a significant risk factor for suicide and a common psychiatric diagnosis in patients who contemplate suicide. Over 50% of those who die by committing suicide suffer from a mood disorder including depression.
Even though major depression remains under-diagnosed and under-treated, there has been a progressive increase in the utilization of antidepressants,, particularly the selective serotonin reuptake inhibitors (SSRIs). This issue of the journal features an article by the Malhotra et al who conducted a naturalistic study to determine the prognostic significance of suicidal ideation in primary care patients receiving antidepressants. The routine clinical care included the use of psychotherapy in some patients. Contrary to their hypothesis, the authors found that at the end of four-month therapy, the response and remission rates were similar in patients with suicidal ideation and those without such ideation. In addition, the response to treatment did not vary with the type of antidepressant medication used.
Notwithstanding the methodological shortcomings usually associated with a retrospective, open trial, this study provides useful clinical information. An important finding is that antidepressants are safe and effective in the treatment of moderately severe depression with current suicidal ideation. This is a significant finding in the light of the view expressed by some that the use of SSRIs might induce suicidality in some patients.,
There are, however, some caveats that should be considered while interpreting the results reported in the study. For example, personality features such as social desirability rather than the illness variables might mediate the reporting of suicidal ideation. In this study, a single variable (admission of suicidal ideation) was used as the basis for establishing dichotomous illness groups. Such a procedure is not uncommon in psychiatric research. But we are less aware of it being done when the difference between groups is found to be statistically significant. The present finding of no difference can be taken as a reminder that a vivid illness feature such as suicidal ideation does not naturally mean that such patients have an illness that is qualitatively different from those who do not endorse suicidality.
|1||Wilson I, Duszynski K, Mant A. A 5-year follow-up of general practice patients experiencing depression. Fam Prac 2003;20:685-9.|
|2||Lecrubier Y. The burden of depression and anxiety in general medicine. J Clin Psychiatry 2001;62(Supp 8):10-1.|
|3||Murray CJL, Lopez AD, editors. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Vol 1 of Global burden of disease and injury series. Cambridge (MA): Harvard School of Public Health 1996.|
|4||Chen YW, Disalver SC. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders. Biol Psychiatry 1996;39:896-9.|
|5||Hemels ME, Koren G, Einarson TR. Increased use of antidepressants in Canada: 1981-2000. Ann Pharmacother 2002;36:1375-9.|
|6||Wilson I, Duszynski K, Mant A. A 5-year follow-up of general practice patients experiencing depression. Fam Pract 2003;20:685-9.|
|7||Malhotra K, Schwartz T, Hameed U. Presence of Suicidality as a Prognostic Indicator. J Postgrad Med 2004;185-8.|
|8||Healy D, Whitaker C. Antidepressants and suicide: Risk-benefit conundrums. J Psychiatry Neurosci 2003;28:331-7.|
|9||Lapierre Y. Suicidality with selective serotonin reuptake inhibitors: Valid claim? J Psychiatry Neurosci 2003;28:340-7.|