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Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial
Published online by Cambridge University Press: 20 October 2023
Abstract
Background
Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a ‘next-step’. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted.
Method
The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored.
Results
Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to ‘next-step’ treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI.
Conclusion
SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.
Keywords
antidepressant medicationsdifficult to treat depressionmajor depressive disordernext-step treatmentssafetysuicidal ideationsuicidal thoughts and behaviorssuicidesuicide risktreatment emergent suicidalitytreatment resistant depressionVA Augmentation and Swritching Treatments for Depression (VAST-D) study
- Type
- Original Article
- Information
- Creative Commons
- This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press
- Copyright
- Copyright © Department of Veteran Affairs, 2023
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.Google Scholar
Bachmann, S. (2018). Epidemiology of suicide and the psychiatric perspective. International Journal of Environmental Research and Public Health, 15(7), 1425. doi:10.3390/ijerph15071425CrossRefGoogle ScholarPubMed
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. doi:10.1037/0022-006X.56.6.893CrossRefGoogle ScholarPubMed
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., … Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect: The International Journal, 27(2), 169–190. doi:10.1016/S0145-2134(02)00541-0CrossRefGoogle ScholarPubMed
Borges, G., Angst, J., Nock, M. K., Ruscio, A. M., & Kessler, R. C. (2008). Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys. Journal of Affective Disorders, 105(1–3), 25–33. doi:10.1016/j.jad.2007.01.036CrossRefGoogle ScholarPubMed
Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100.CrossRefGoogle ScholarPubMed
Cai, H., Jin, Y., Liu, S., Zhang, Q., Zhang, L., Cheung, T., … Xiang, Y. T. (2021). Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies. Journal of Affective Disorders, 293, 148–158. doi:10.1016/j.jad.2021.05.115CrossRefGoogle ScholarPubMed
Canuso, C. M., Ionescu, D. F., Li, X., Qiu, X., Lane, R., Turkoz, I., … Fu, D. J. (2021). Esketamine nasal spray for the rapid reduction of depressive symptoms in major depressive disorder with acute suicidal ideation or behavior. Journal of Clinical Psychopharmacology, 41(5), 516.CrossRefGoogle ScholarPubMed
Claassen, C. A., Trivedi, M. H., Rush, A. J., Husain, M. M., Zisook, S., Young, E., … Alpert, J. (2007). Clinical differences among depressed patients with and without a history of suicide attempts: Findings from the STAR-D trial. Journal of Affective Disorders, 97(1–3), 77–84. doi:10.1016/j.jad.2006.05.026CrossRefGoogle ScholarPubMed
Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin, 29(2), 321–326. doi:10.1037/t49981-000Google ScholarPubMed
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. doi:10.1016/S0749-3797(98)00017-8CrossRefGoogle ScholarPubMed
Group, T. E. (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health policy, 16(3), 199–208.Google Scholar
Guy, W. (1976). Clinical global impressions scale. ECDEU assessment manual for psychopharmacology. US Dept Health, Education, and Welfare Publication (AMD), 76, 338, 221–227.Google Scholar
Heagerty, P. J., & Zeger, S. L. (1996). Marginal regression models for clustered ordinal measurements. Journal of the American Statistical Association, 91(435), 1024–1036. doi.org/10.2307/2291722.CrossRefGoogle Scholar
Hochschild, A., Grunebaum, M. F., & Mann, J. J. (2021). The rapid anti-suicidal ideation effect of ketamine: A systematic review. Preventive Medicine, 152, 106524.CrossRefGoogle ScholarPubMed
Johnston, K. M., Powell, L. C., Anderson, I. M., Szabo, S., & Cline, S. (2019). The burden of treatment-resistant depression: A systematic review of the economic and quality of life literature. Journal of Affective Disorders, 242, 195–210. doi:10.1016/j.jad.2018.06.045CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9. Journal of General Internal Medicine, 9(16), 606–613. doi:10.1046/j.1525-1497.2001.016009606.xCrossRefGoogle Scholar
Large, M., Corderoy, A., & McHugh, C. (2021). Is suicidal behavior a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 55(3), 254–267.CrossRefGoogle ScholarPubMed
Lopez-Castroman, J., Jaussent, I., Gorwood, P., & Courtet, P. (2016). Suicidal depressed patients respond less well to antidepressants in the short term. Depression and Anxiety, 33(6), 483–494. doi:10.1002/da.22473CrossRefGoogle ScholarPubMed
Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021). Improving suicide prevention through evidence-based strategies: A systematic review. American Journal of Psychiatry, 178(7), 611–624. doi:10.1176/appi.ajp.2020.20060864CrossRefGoogle ScholarPubMed
May, A. M., & Klonsky, E. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology: Science and Practice, 23, 5–20.Google Scholar
Mohamed, S., Johnson, G. R., Chen, P., Hicks, P. B., Davis, L. L., Yoon, J., … Little, J. T. (2017). Effect of antidepressant switching vs augmentation on remission Among patients with major depressive disorder unresponsive to antidepressant treatment: The VAST-D randomized clinical trial. JAMA, 318(2), 132–145. doi:10.1001/jama.2017.8036CrossRefGoogle ScholarPubMed
Mohamed, S., Johnson, G. R., Vertrees, J. E., Guarino, P. D., Weingart, K., Young, I. T., … Zisook, S. (2015). The VA augmentation and switching treatments for improving depression outcomes (VAST-D) study: Rationale and design considerations. Psychiatry Research, 229(3), 760–770. doi:10.1016/j.psychres.2015.08.005CrossRefGoogle ScholarPubMed
Moitra, M., Santomauro, D., Degenhardt, L., Collins, P. Y., Whiteford, H., Vos, T., & Ferrari, A. (2021). Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis. Journal of Psychiatric Research, 137, 242–249.CrossRefGoogle ScholarPubMed
Nichter, B., Stein, M. B., Norman, S. B., Hill, M. L., Straus, E., Haller, M., & Pietrzak, R. H. (2021). Prevalence, correlates, and treatment of suicidal behavior in US military veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study. Journal of Clinical Psychiatry, 82(5), e13714–e13714. doi:10.4088/JCP.20m13714Google ScholarPubMed
Nordentoft, M., Mortensen, P. B., & Pedersen, C. B. (2011). Absolute risk of suicide after first hospital contact in mental disorder. Archives of General Psychiatry, 68(10), 1058–1064. doi:10.1001/archgenpsychiatry.2011.113CrossRefGoogle ScholarPubMed
Pompili, M., Baldessarini, R. J., Forte, A., Erbuto, D., Serafini, G., Fiorillo, A., … Girardi, P. (2016). Do atypical antipsychotics have antisuicidal effects? A hypothesis-generating overview. International Journal of Molecular Sciences, 17(10), 1700. doi.org/10.1016/j.pnpbp.2006.09.015CrossRefGoogle ScholarPubMed
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277.CrossRefGoogle ScholarPubMed
Rush, A. J., Kraemer, H. C., Sackeim, H. A., Fava, M., Trivedi, M. H., Frank, E., … Schatzberg, A. F. (2006). Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology, 31(9), 1841–1853. doi:10.1038/sj.npp.1301131CrossRefGoogle ScholarPubMed
Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., … Thase, M. E. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583. doi:10.1016/S0006-3223(02)01866-8CrossRefGoogle ScholarPubMed
Shear, K. M., Jackson, C. T., Essock, S. M., Donahue, S. A., & Felton, C. J. (2006). Screening for complicated grief among Project Liberty service recipients 18 months after September 11, 2001. Psychiatric Services, 57(9), 1291–1297. doi:10.1176/appi.ps.57.9.1291CrossRefGoogle ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22–33.Google ScholarPubMed
Spijker, J., de Graaf, R., Ten Have, M., Nolen, W. A., & Speckens, A. (2010). Predictors of suicidality in depressive spectrum disorders in the general population: Results of the Netherlands Mental Health Survey and Incidence Study. Social Psychiatry and Psychiatric Epidemiology, 45, 513–521.CrossRefGoogle ScholarPubMed
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. doi.org/10.1016/j.cbpra.2011.01.001CrossRefGoogle Scholar
Stone, D. M., Mack, K. A., & Qualters, J. (2023). Notes from the field: Recent changes in suicide rates, by race and ethnicity – United States, 2021. MMWR. Morbidity and Mortality Weekly Report, 72, 160–162. http://dx.doi.org/10.15585/mmwr.mm7206aa4CrossRefGoogle ScholarPubMed
Tunnard, C., Rane, L. J., Wooderson, S. C., Markopoulou, K., Poon, L., Fekadu, A., … Cleare, A. J. (2014). The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression. Journal of Affective Disorders, 152, 122–130. doi.org/10.1016/j.jad.2013.06.037CrossRefGoogle ScholarPubMed
Wiebenga, J. X., Eikelenboom, M., Heering, H. D., van Oppen, P., & Penninx, B. W. (2021). Suicide ideation versus suicide attempt: Examining overlapping and differential determinants in a large cohort of patients with depression and/or anxiety. Australian & New Zealand Journal of Psychiatry, 55(2), 167–179.CrossRefGoogle ScholarPubMed
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659.CrossRefGoogle ScholarPubMed
Zisook, S., Johnson, G. R., Tal, I., Hicks, P., Chen, P., Davis, L., … Mohamed, S. (2019). General predictors and moderators of depression remission: A VAST-D report. American Journal of Psychiatry, 176(5), 348–357. doi.org/10.1176/appi.ajp.2018.18091079CrossRefGoogle ScholarPubMed
Zisook, S., Lesser, I. M., Lebowitz, B., Rush, A. J., Kallenberg, G., Wisniewski, S. R., … Trivedi, M. H. (2011). Effect of antidepressant medication treatment on suicidal ideation and behavior in a randomized trial: An exploratory report from the Combining Medications to Enhance Depression Outcomes Study. Journal of Clinical Psychiatry, 72(10), 1322–1332. doi:10.4088/JCP.10m06724CrossRefGoogle Scholar
Zisook, S., Mohamad, S., Johnson, G., Tal, I., Villarreal, G., Wilcox, J. A., & Shear, K. M. (2021). Clinical implications of co-occurring prolonged grief disorder in patients with treatment-resistant major depressive disorder. World Psychiatry, 20(2), 303. doi:10.1002/wps.20877CrossRefGoogle ScholarPubMed
Zisook, S., Tal, I., Weingart, K., Hicks, P., Davis, L. L., Chen, P., … Mohamed, S. (2016). Characteristics of US veteran patients with major depressive disorder who require “next-step” treatments: A VAST-D report. Journal of Affective Disorders, 206, 232–240. doi.org/10.1016/j.ad.2016.07.023CrossRefGoogle ScholarPubMed
Zisook, S., Trivedi, M. H., Warden, D., Lebowitz, B., Thase, M. E., Stewart, J. W., … Rush, A. J. (2009). Clinical correlates of the worsening or emergence of suicidal ideation during SSRI treatment of depression: An examination of citalopram in the STAR⁎D study. Journal of Affective Disorders, 117(1–2), 63–73. doi.org/10.1016/j.jad.2009.01.002CrossRefGoogle ScholarPubMed
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