Tondo L, Lepri B, Baldessarini R J
Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, MA, USA.
Acta Psychiatr Scand. 2008 Aug;118(2):106-15. doi: 10.1111/j.1600-0447.2008.01178.x. Epub 2008 Apr 7.
Relationships between antidepressant treatment and suicidality remain uncertain in major depressive disorder (MDD), and rarely evaluated in bipolar disorder (BPD).
We evaluated changes in suicidality ratings (Hamilton Depression Rating Scale item-3) at the start and after 3.59 +/- 2.57 months of sustained antidepressant treatment in a systematically assessed clinical sample (n = 789) of 605 patients with MDD, 103 patients with BPD-II and 81 patients with BPD-I (based on DSM-IV; 68.1% women; aged 44.3 +/- 16.1 years), comparing suicidal vs. non-suicidal and recovered vs. unrecovered initially suicidal patients.
Suicidal patients (103/789, 16.5%; BPD/MDD risk: 2.2) were more depressed and were ill longer. During treatment, 81.5% of suicidal patients became non-suicidal; 0.46% of 656 initially non-suicidal patients reported new suicidal thoughts, with no new attempts. Becoming non-suicidal was associated with greater depression severity and greater improvement.
Suicidal ideation was prevalent in patients with depressed major affective disorder, but most of the initially suicidal patients became non-suicidal with antidepressant treatment, independent of diagnosis, treatment type or dose.
在重度抑郁症（MDD）中，抗抑郁治疗与自杀倾向之间的关系仍不明确，且在双相情感障碍（BPD）中很少进行评估。
我们评估了605例MDD患者、103例II型BPD患者和81例I型BPD患者（基于《精神疾病诊断与统计手册》第四版；68.1%为女性；年龄44.3±16.1岁）组成的系统评估临床样本（n = 789）在开始持续抗抑郁治疗时以及治疗3.59±2.57个月后的自杀倾向评分（汉密尔顿抑郁量表第3项）变化，比较自杀患者与非自杀患者以及最初有自杀倾向的患者中康复与未康复的情况。
自杀患者（103/789，16.5%；BPD/MDD风险：2.2）抑郁程度更高，患病时间更长。治疗期间，81.5%的自杀患者不再有自杀倾向；656例最初无自杀倾向的患者中有0.46%报告出现新的自杀念头，但无新的自杀行为。不再有自杀倾向与更严重的抑郁程度和更大的改善相关。
在重度情感障碍抑郁症患者中自杀观念普遍存在，但大多数最初有自杀倾向的患者在接受抗抑郁治疗后不再有自杀倾向，这与诊断、治疗类型或剂量无关。
