Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharmacotherapy may have different effects on the occurrence and seriousness of suicide attempts.

Our objective in this article is to assess the relation between long-term treatments of depressive episodes and attempted or completed suicide in patients who had had a severe depression at index admission. A blind record evaluation of 96 suicides with a primary severe depression and matched controls has been performed. Out of those, 57 and 33, respectively, had made suicide attempts. Occurrence of attempt was less common after electroconvulsive therapy (ECT). However, seriousness of suicide attempt appeared to be reduced in those with at least 4 weeks of antidepressant medication compared to no treatment and ECT. The theory of a suicidal syndrome independent of depression seems supported. Continuation treatment after ECT is recommended. Copyright 2005 Wiley-Liss, Inc.