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Related Experiment Videos

Active suicidal ideation during clinical antidepressant trials.

Elizabeth D Ballard1, Sam L Snider1, Allison C Nugent1

  • 1Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.

Psychiatry Research
|August 9, 2017
PubMed
Summary

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Active suicidal ideation (SI) in patients with major depressive disorder or bipolar disorder is often unstable, fluctuating significantly over short periods. This suggests research in these populations is feasible with careful monitoring.

Area of Science:

  • Psychiatry
  • Neuroscience
  • Clinical Psychology

Background:

  • Suicidal patients are frequently excluded from psychiatric clinical trials and neurobiological research.
  • Understanding the presence and stability of active suicidal ideation (SI) is crucial for including these patients in research.

Purpose of the Study:

  • To evaluate the prevalence, impact, and temporal stability of active SI in patients with major depressive disorder (MDD) or bipolar disorder (BD) participating in antidepressant trials.
  • To assess the feasibility of conducting neurobiological research in patients experiencing active SI.

Main Methods:

  • Review of 14 clinical trials involving 269 participants with MDD or BD.
  • Identification and tracking of active SI throughout study participation.
  • Evaluation of SI stability using intraclass correlation coefficients (ICCs) and comparison with other depressive symptoms.
Keywords:
Clinical trialsDepressionNeuroimagingSafetySuicidal ideationSuicide

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Main Results:

  • 23% of participants (63/269) reported active SI at some point during the trials.
  • A significant proportion of participants experiencing active SI also underwent neuroimaging or polysomnography.
  • Only 39% of patients continued to report active SI after three days without additional treatment, indicating high fluctuation.
  • Intraclass correlation coefficients (ICCs) were not significant for SI or pessimism, unlike other depressive symptoms.

Conclusions:

  • Active SI in patients with MDD or BD is often transient and highly variable.
  • Neurobiological research can be conducted in patients with active SI, provided careful observation and monitoring protocols are in place.
  • Active SI and pessimism represent potentially unstable symptom clusters in these patient populations.