BACKGROUND: Treatment-Emergent Suicidal Ideation (TESI) in older adults is poorly understood. We characterized TESI in older depressed adults during treatment with venlafaxine and explored whether TESI is related to antidepressant exposure versus dimensions of the psychiatric illness. We examined the relationship among medication exposure, onset of TESI, and clinical characteristics. METHODS: We analyzed data on 233 clinical trial participants with major depression and no baseline suicidal ideation who were treated for up to 12 weeks with venlafaxine XR (target dose: 150-300 mg/day). Suicidal ideation was assessed weekly with the Scale for Suicide Ideation. A Kaplan-Meier curve displayed the time course of TESI. Differences in baseline demographic and clinical variables between the TESI and Non-TESI groups were assessed with analyses of covariance or logistic regression. A final multivariate logistic regression model indicated baseline predictors of TESI. Depression treatment outcomes in subjects developing TESI versus those who did not were examined with a mixed effects model. RESULTS: TESI occurred in 10% of participants, typically with onset within 4 weeks of the start of treatment. Anxiety, and depression severity at baseline were predictors of TESI. Most TESI was mild and transient, with 6/233 participants having TESI considered clinically meaningful. TESI was not associated with venlafaxine blood levels or side effects. CONCLUSIONS: In older depressed adults, TESI is relatively uncommon and it is likely related to the underlying illness rather than to a medication adverse effect. This suggests that TESI requires continuing rather than discontinuing antidepressant treatment.
BACKGROUND: Treatment-Emergent Suicidal Ideation (TESI) in older adults is poorly understood. We characterized TESI in older depressed adults during treatment with venlafaxine and explored whether TESI is related to antidepressant exposure versus dimensions of the psychiatric illness. We examined the relationship among medication exposure, onset of TESI, and clinical characteristics. METHODS: We analyzed data on 233 clinical trial participants with major depression and no baseline suicidal ideation who were treated for up to 12 weeks with venlafaxine XR (target dose: 150-300 mg/day). Suicidal ideation was assessed weekly with the Scale for Suicide Ideation. A Kaplan-Meier curve displayed the time course of TESI. Differences in baseline demographic and clinical variables between the TESI and Non-TESI groups were assessed with analyses of covariance or logistic regression. A final multivariate logistic regression model indicated baseline predictors of TESI. Depression treatment outcomes in subjects developing TESI versus those who did not were examined with a mixed effects model. RESULTS:TESI occurred in 10% of participants, typically with onset within 4 weeks of the start of treatment. Anxiety, and depression severity at baseline were predictors of TESI. Most TESI was mild and transient, with 6/233 participants having TESI considered clinically meaningful. TESI was not associated with venlafaxine blood levels or side effects. CONCLUSIONS: In older depressed adults, TESI is relatively uncommon and it is likely related to the underlying illness rather than to a medication adverse effect. This suggests that TESI requires continuing rather than discontinuing antidepressant treatment.
Authors: Roy H Perlis; Charles M Beasley; James D Wines; Roy N Tamura; Cristina Cusin; Deborah Shear; Jay Amsterdam; Frederick Quitkin; Robert E Strong; Jerrold F Rosenbaum; Maurizio Fava Journal: Psychother Psychosom Date: 2007 Impact factor: 17.659
Authors: M D Miller; C F Paradis; P R Houck; S Mazumdar; J A Stack; A H Rifai; B Mulsant; C F Reynolds Journal: Psychiatry Res Date: 1992-03 Impact factor: 3.222
Authors: Katalin Szanto; Benoit H Mulsant; Patricia R Houck; Mary Amanda Dew; Alexandre Dombrovski; Bruce G Pollock; Charles F Reynolds Journal: J Affect Disord Date: 2006-08-24 Impact factor: 4.839
Authors: Judit Balázs; Franco Benazzi; Zoltán Rihmer; Annamária Rihmer; K K Akiskal; H S Akiskal Journal: J Affect Disord Date: 2006-02-03 Impact factor: 4.839
Authors: Charles F Reynolds; Mary Amanda Dew; Lynn M Martire; Mark D Miller; Jill M Cyranowski; Eric Lenze; Ellen M Whyte; Benoit H Mulsant; Bruce G Pollock; Jordan F Karp; Ariel Gildengers; Katalin Szanto; Alexandre Y Dombrovski; Carmen Andreescu; Meryl A Butters; Jennifer Q Morse; Patricia R Houck; Salem Bensasi; Sati Mazumdar; Jacqueline A Stack; Ellen Frank Journal: Int J Geriatr Psychiatry Date: 2010-11 Impact factor: 3.485
Authors: Sidney Zisook; Madhukar H Trivedi; Diane Warden; Barry Lebowitz; Michael E Thase; Jonathan W Stewart; Christine Moutier; Maurizio Fava; Stephen R Wisniewski; James Luther; A John Rush Journal: J Affect Disord Date: 2009-02-14 Impact factor: 4.839
Authors: George S Alexopoulos; Charles F Reynolds; Martha L Bruce; Ira R Katz; Patrick J Raue; Benoit H Mulsant; David W Oslin; Thomas Ten Have Journal: Am J Psychiatry Date: 2009-06-15 Impact factor: 18.112
Authors: John Kasckow; Ada Youk; Stewart J Anderson; Mary Amanda Dew; Meryl A Butters; Megan M Marron; Amy E Begley; Katalin Szanto; Alexander Y Dombrovski; Benoit H Mulsant; Eric J Lenze; Charles F Reynolds Journal: J Psychiatr Res Date: 2015-11-19 Impact factor: 4.791
Authors: Yasmina M Saade; Ginger Nicol; Eric J Lenze; J Philip Miller; Michael Yingling; Julie Loebach Wetherell; Charles F Reynolds; Benoit H Mulsant Journal: Depress Anxiety Date: 2019-11-04 Impact factor: 6.505
Authors: Helen Mulholland; Jason C McIntyre; Alina Haines-Delmont; Richard Whittington; Terence Comerford; Rhiannon Corcoran Journal: BMJ Open Date: 2021-02-04 Impact factor: 2.692
Authors: Giuseppe Fanelli; Marcus Sokolowski; Danuta Wasserman; Siegfried Kasper; Joseph Zohar; Daniel Souery; Stuart Montgomery; Diego Albani; Gianluigi Forloni; Panagiotis Ferentinos; Dan Rujescu; Julien Mendlewicz; Diana De Ronchi; Alessandro Serretti; Chiara Fabbri Journal: Am J Med Genet B Neuropsychiatr Genet Date: 2022-02-21 Impact factor: 3.358