Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis

Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and […]

Suicide rates and prescription of antidepressants: Trends in the United States, 1999-2020, by sex and race/ethnicity

Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Method: The study protocol was pre-registered on the Open Science Framework (https://osf.io/978sk/). Publicly available data from the Centers for Disease […]

Risk of suicidal behaviors and antidepressant exposure among children and adolescents: A meta-analysis of observational studies

Objectives: Although several studies have reviewed the suicidal risk of antidepressants, the conclusions remain inconsistent. We, therefore, performed a meta-analysis of observational studies to address the association between exposure to antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and the risk of suicide and suicide attempt in children and adolescents. Methods: MEDLINE and Embase were searched from January […]

Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: An open cohort study using English primary care data

Background There is an increasing demand for mental health services for young people, which may vary across the year. Objective To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults. Methods This cohort study used anonymised electronic health records from general practices in England contributing to QResearch. […]

No benefit of antidepressants in inpatient treatment of depression: A longitudinal, quasi‑experimental field study

Objectives The benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design. Methods Depressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two […]

Suicidal behavior in mood disorders: Response to pharmacological treatment

Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with […]

Clinical characteristics and prescriptions associated with a 2-year course of rapid cycling and euthymia in bipolar disorder: A multicenter treatment survey for bipolar disorder in psychiatric clinics

Objective: In patients with bipolar disorder (BD), rapid cycling (RC) presents a risk for a more severe illness, while euthymia (EUT) has a better prognosis. This study focused on the progression of RC and EUT, which are contrasting phenomenology, and aimed to clarify the influence of patient backgrounds and prescription patterns on these different progressions, using […]

Selective serotonin reuptake inhibitors and suicidality in children and young adults: Analyses of pharmacovigilance databases

Background: Since the warnings by the United States (US) and European regulatory authorities in 2004 and 2005 it had been discussed whether there is some link between selective serotonin reuptake inhibitors (SSRIs) and suicidality in the pediatric population. The aim of our study was to describe trends and patterns in spontaneous reporting data referring to suicidality […]

Pharmacological mechanism of ketamine in suicidal behavior based on anima models of aggressiveness and impulsivity: A narrative review

Around 700,000 people die from suicide each year in the world. Approximately 90% of suicides have a history of mental illness, and more than two-thirds occur during a major depressive episode. Specific therapeutic options to manage the suicidal crisis are limited and measures to prevent acting out also remain limited. Drugs shown to reduce the […]

Effect of the FDA black box suicidality warnings for antidepressants on suicide rates in the USA: Signal or noise?

Background: Some authors claimed that the US Food and Drug Administration (FDA) black box warning on treatment-emergent suicidality with antidepressants in adolescents (issued 2004) and young adults (issued 2006) led to an increase of suicides, based on the analyses of ecological data with debatable assumptions about putative changes in suicide rates. Aims: To explore if putative changes in […]

The change of suicidal ideation over a 12-week naturalistic treatment of depression: Comparison between young people and older adults

Objective We investigated the differences in suicidality between young people and older adults with depression over the course of 12-week naturalistic treatment with antidepressants. Methods A total of 565 patients who had moderate to severe depression (Hamilton Depression Rating Scale [HAM-D] score ≥14) and significant suicidal ideation (Beck Scale for Suicide Ideation [SSI-B] score ≥6) […]

Antidepressants in children and adolescents: Meta-review of efficacy, tolerability and suicidality in acute treatment

Antidepressants are prescribed for the treatment of a number of psychiatric disorders in children and adolescents, however there is still controversy about whether they should be used in this population. This meta-review aimed to assess the effects of antidepressants for the acute treatment of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders (ADs), autistic spectrum disorder (ASD), enuresis, […]

Antidepressant treatment trajectories and suicide attempt among Australians aged 45 years and older: A population study using individual prescription data

Introduction Meta-analyses show antidepressant initiation has increased risk of suicidal behavior <25 years, no difference 25–64 years and reduced risk 65+ years. Estimating risks from RCTs has limitations and real-world population estimates are uncommon. Methods A self-controlled case series reporting incidence rate ratio (IRR) between exposed and control periods for antidepressants associated with suicide attempt, in Australian […]

Suicidal behavior: Advances in clinical and neurobiological research and improvement of prevention strategies

Suicide is the 14th leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (e.g., control of analgesics and hot-spots for suicide by […]

Incremental burden of relapse in patients with major depressive disorder: A real-world, retrospective cohort study using claims data

Background Relapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD. Methods This real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new […]

Role of ketamine in the treatment of psychiatric disorders

Purpose of review This is a comprehensive review of the literature regarding the use of ketamine as a treatment for treatment-resistant depression (TRD). It covers the epidemiology, risk factors, pathophysiology, and current treatment modalities regarding Major Depressive Disorder (MDD) and TRD. It provides background on the mechanism of action of ketamine, its history, current approved […]

Electrophysiological correlates and predictors of the antidepressant response to repeated ketamine infusions in treatment-resistant depression

Background: Sub-anesthetic ketamine doses rapidly reduce depressive symptoms, although additional investigations of the underlying neural mechanisms and the prediction of response outcomes are needed.  Electroencephalographic (EEG)-derived measures have shown promise in predicting antidepressant response to a variety of treatments, and are sensitive to ketamine administration. This study examined their utility in characterizing changes in depressive […]

Evaluation of factors related to overdose in patients with impaired consciousness who are transported by emergency medical services: An age-specific research

Background: Drug overdose accounts for most of the admissions to the emergency department. Prescription drugs, most of which are psychotropic medications, are often misused for drug overdose. The purpose of this study was to investigate the association between overdose in patients transported with disorders of consciousness and psychotropic medications administered prior to transport, so as to […]

Long-run trends in antidepressant use among youths after the FDA black box warning

Objective: In October 2004, the Food and Drug Administration directed pharmaceutical companies to issue a black box warning about the potential link between the use of antidepressants and suicidal ideation among children. This study analyzed long-run trends in antidepressant use among children before and after the black box warning for those with and without severe psychological […]

The effect of income level on all-cause mortality and suicide among patients using antidepressants: A population-based cohort study

Background: To investigate whether household income levels are associated with all-cause mortality and suicide in patients using antidepressant agents. Methods: We analyzed data from 75,782 patients using antidepressants, acquired from the Korean National Health Insurance claims database (2002-2013). Each patient was monitored until December 2013 or until death, whichever occurred sooner. Cox proportional hazard models were used […]

Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: A systematic review and meta-analysis of observational studies

Background: There is ongoing controversy whether antidepressant use alters suicide risk in adults with depression and other treatment indications. Methods: Systematic review of observational studies, searching MEDLINE, PsycINFO, Web of Science, PsycARTICLES and SCOPUS for case-control and cohort studies. We included studies on depression and various indications unspecified (including off-label use) reporting risk of suicide and/or suicide […]

Increases in suicide deaths among adolescents and young adults following US Food and Drug Administration antidepressant boxed warnings and declines in depression care

Objective Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether suicide deaths increased following the warnings and declines in depression care. Methods We conducted an interrupted time […]

Duty to warn: Antidepressant black box suicidality warning is empirically justified

The United States Food and Drug Administration issued a Black Box warning in October 2004 after placebo-controlled trials of antidepressant medications found an increased risk of suicidal thoughts and behaviors among children and adolescents taking antidepressant medications relative to placebo. Subsequently, some researchers have concluded that the Black Box warning caused severe unintended consequences; specifically, […]