Department of Psychiatry, University of California, San Diego, San Diego VA Medical Center, San Diego, California, USA.
J Affect Disord. 2009 Sep;117(1-2):63-73. doi: 10.1016/j.jad.2009.01.002. Epub 2009 Feb 14.
Untreated major depressive disorder (MDD) is a major risk factor for suicide, but some data suggest antidepressants may be associated with increased suicidal ideation (SI) in some depressed patients. The purpose of this study was to determine whether, and in whom, treatment of MDD is associated with increased or emergent SI.
Patients were treated with Citalopram, 10-60 mg/day for 12-14 weeks. A score >0 on Item 12 of the Quick Inventory of Depressive Symptomatology - Self-Report indicated the presence of SI. Worsening was defined by a >or=1 point increase. Emergent SI was defined by an increase from 0 at baseline to >or=1 during treatment.
Of the 1909 participants with baseline SI, 57% experienced improvement in SI by their first post-baseline visit and 5% worsened. By the final visit, 74% experienced improvement and 4% worsened. Of 1721 participants without baseline SI, 7% experienced emergence by the first postbaseline visit. Of these, 63% had no SI at their final visit. Major risk factors for treatment-emergent SI at the first treatment visit were drug abuse, severe depression and melancholic features.
Main limitations are lack of a comparison group to help pinpoint whether citalopram treatment added risk or protection, a placebo group to determine whether changes in SI were related to illness factors, medication effects or other factors, and more detailed and validated measures of SI.
SI and behaviors, core features of MDD, wax and wane in intensity before, during, and perhaps after treatment. It is clinically important to understand risk factors, maintain careful surveillance and treat as vigorously as necessary to attain remission.
未经治疗的重度抑郁症（MDD）是自杀的主要危险因素，但一些数据表明，抗抑郁药可能会使一些抑郁患者出现更多的自杀意念（SI）。本研究的目的是确定 MDD 的治疗是否与 SI 的增加或出现有关，以及在哪些患者中会出现这种情况。
患者接受西酞普兰治疗，剂量为 10-60mg/天，治疗 12-14 周。快速抑郁症状自评量表-自我报告的第 12 项得分>0 表示存在 SI。恶化定义为增加>或=1 分。新发 SI 定义为从基线时的 0 分增加到治疗期间的>或=1 分。
在 1909 名基线时有 SI 的参与者中，57%的患者在首次随访后 SI 得到改善，5%的患者恶化。在最后一次随访时，74%的患者改善，4%的患者恶化。在 1721 名基线时无 SI 的参与者中，有 7%的人在首次随访后出现新发 SI。其中，63%的人在最后一次随访时没有 SI。首次治疗时出现治疗性新发 SI 的主要危险因素是药物滥用、严重抑郁和忧郁特征。
主要限制因素是缺乏对照组来帮助确定西酞普兰治疗是否增加了风险或保护，缺乏安慰剂组来确定 SI 的变化是否与疾病因素、药物作用或其他因素有关，以及缺乏更详细和更有效的 SI 测量方法。
SI 和行为是 MDD 的核心特征，在治疗前、治疗期间和治疗后，其强度会时强时弱。了解危险因素、保持密切监测以及积极治疗以达到缓解非常重要。
