Suicidal Ideation During Treatment of Depression With Escitalopram and Nortriptyline in Genome-Based Therapeutic Drugs for Depression (GENDEP): a Clinical Trial

In a multicentre part-randomised open-label study, 811 adult patients with moderate to severe unipolar depression were allocated to flexible dosage of escitalopram or nortriptyline for 12 weeks. The suicidality items of 3 standard measures were integrated into a suicide ideation score. Suicide ideation decreased during antidepressant treatment. Rates of treatment emergent suicide ideation & treatment worsening suicide ideation peaked in the fifth week. In men, nortriptyline was associated with a 9.8-fold & 2.4-fold increase in treatment emergent & treatment worsening suicide ideation compared to escitalopram, respectively. Retirement & history of suicide attempts predicted treatment worsening suicide ideation. (45 refs.)