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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

Sidney Zisook Open the ORCID record for Sidney Zisook [Opens in a new window] ,
Christine Yu Moutier Open the ORCID record for Christine Yu Moutier [Opens in a new window] ,
A. John Rush Open the ORCID record for A. John Rush [Opens in a new window] ,
Gary R Johnson Open the ORCID record for Gary R Johnson [Opens in a new window] ,
Ilanit Tal ,
PJ. Chen Open the ORCID record for PJ. Chen [Opens in a new window] ,
Lori L Davis Open the ORCID record for Lori L Davis [Opens in a new window] ,
Paul B Hicks Open the ORCID record for Paul B Hicks [Opens in a new window] ,
James Wilcox  and
Beata Planeta Open the ORCID record for Beata Planeta [Opens in a new window]
...Show all authors
Sidney Zisook*
Affiliation:
University of California San Diego, San Diego, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
Christine Yu Moutier
Affiliation:
American Foundation for Suicide Prevention, New York, NY, USA
A. John Rush
Affiliation:
Duke Medical School, Durham, NC, USA Duke-National University of Singapore, Singapore
Gary R Johnson
Affiliation:
Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
Ilanit Tal
Affiliation:
VA San Diego Healthcare System, San Diego, CA, USA
PJ. Chen
Affiliation:
Department of Psychiatry, VA Northeast Ohio Healthcare System, and Case Western Reserve University School of Medicine, Cleveland, OH, USA
Lori L Davis
Affiliation:
Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
Paul B Hicks
Affiliation:
Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, USA
James Wilcox
Affiliation:
Department of Veterans Affairs, Phoenix, AZ, USA
Beata Planeta
Affiliation:
Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
Kimberly (Weingart) Lauro
Affiliation:
VA San Diego Healthcare System, San Diego, CA, USA
Alexandra A. Scrymgeour
Affiliation:
Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
John Kasckow
Affiliation:
University of Pittsburgh Physicians, Pittsburgh, PA, USA
Somaia Mohamed
Affiliation:
Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
*
Corresponding author: Sidney Zisook; Email: szisook@ucsd.edu
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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
Psychological Medicine , Volume 54 , Issue 6 , April 2024 , pp. 1172 - 1183
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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

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