University of California San Diego, San Diego, CA, USA.
VA San Diego Healthcare System, San Diego, CA, USA.
Psychol Med. 2024 Apr;54(6):1172-1183. doi: 10.1017/S0033291723003008. Epub 2023 Oct 20.
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.
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.
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.
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.
重度抑郁症（MDD）会增加自杀风险。有效治疗 MDD 被认为是预防自杀的关键干预措施。然而，许多 MDD 患者对初始药物治疗没有反应，需要“下一步”治疗。下一步治疗与自杀念头和行为之间的关系尚未确定。
VA 增强和转换治疗抑郁症试验将 1522 名参与者随机分为三种下一步治疗之一：转换为安非他酮、联合安非他酮和阿立哌唑增效。在这项二次分析中，探讨了基线时与终生自杀意念（SI）和尝试（SA）以及治疗期间当前 SI 相关的特征。
与仅存在 SI 的患者相比，存在终生 SI + SA 的患者更可能为女性、离婚或分居、失业；并且经历了更多的童年逆境。他们的抑郁发作更严重，更有可能对“下一步”治疗有反应。SI 的患病率从基线时的 46.5%（694/1492）下降到治疗结束时的 21.1%（315/1492）。治疗期间的 SI 与基线 SI 相关；心理健康水平低、更多焦虑、当前 MDD 发作的严重程度和持续时间更长；为男性和白人；与 S-BUP 或 C-BUP 治疗相比，与 A-ARI 治疗相关。
大多数患者在下一步药物治疗期间的 SI 下降。但约有 1/5 的患者在治疗期间出现新发或恶化的 SI，因此在整个 12 周急性治疗期间需要警惕自杀风险。治疗选择可能会影响 SI 的风险。
