Nobile B1, Jaussent I2, Gorwood P3, Lopez Castroman J4, Olié E5, Guillaume S5, Courtet P5.
Author information
- 1 Inserm U1061, France, University of Montpellier, Montpellier, France. Electronic address: benedicte.nobile@gmail.com.
- 2 Inserm U1061, France, University of Montpellier, Montpellier, France.
- 3 Inserm U675-U894, Centre of Psychiatry and Neurosciences, Paris, France.
- 4 Inserm U1061, France, University of Montpellier, Montpellier, France; Department of Psychiatry, CHU Nimes, Nimes, France.
- 5 Inserm U1061, France, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; FondaMental Foundation, France.
J Psychiatr Res. 2018 Jan;96:167-170. doi: 10.1016/j.jpsychires.2017.10.007. Epub 2017 Oct 16.
Sujet : L'aggravation de l'idéation suicidaire au cours des premières semaines de traitement aux antidépresseurs est un phénomène mal compris qui a incité les organismes de réglementation à émettre des avertissements spécifiques. Pour mieux comprendre les causes de ce phénomène, cette étude a comparé le risque d'aggravation de l'idéation suicidaire chez des patients prenant différents types d'antidépresseurs. A cet effet, 4017 patients ambulatoires adultes dépressifs ont été suivis par des médecins généralistes et psychiatres dans toute la France pendant 6 semaines après prescription d'un traitement antidépresseur.
Abstract
Worsening of suicidal ideation during the first weeks of antidepressant treatment is a poorly understood phenomenon that prompted regulatory bodies to issue specific warnings. To better understand the causes of this phenomenon, this study compared the risk of suicidal ideation worsening in patients taking different types of antidepressant medications. To this aim, 4017 depressed adult outpatients were followed by general practitioners and psychiatrists throughout France for 6 weeks after prescription of an antidepressant treatment. The main study outcomes were to monitor changes (worsening or improvement) in suicidal ideation between baseline (treatment onset) and the study end (week 6) and to determine the remission rates according to the treatment type. Depression severity was assessed with the patient-administered Hospital Anxiety and Depression Scale and suicidal ideation with the 9-item Montgomery-Asberg Depression Rating Scale and the Hopelessness Scale. Use of tianeptine, a mu-opioid receptor agonist was significantly associated with a lower risk of suicidal ideation worsening compared with other antidepressants in the first 6 weeks of treatment. Conversely, remission rates were not significantly affected by the treatment type. Our results highlight a potential interest of opioid agonists to reduce the risk of worsening of suicidal ideation at antidepressant initiation.
KEYWORDS:
Antidepressants; Depression; Suicidal ideation; Suicide; Tianeptine; Treatment worsening suicidal ideation
Sujet : L'aggravation de l'idéation suicidaire au cours des premières semaines de traitement aux antidépresseurs est un phénomène mal compris qui a incité les organismes de réglementation à émettre des avertissements spécifiques. Pour mieux comprendre les causes de ce phénomène, cette étude a comparé le risque d'aggravation de l'idéation suicidaire chez des patients prenant différents types d'antidépresseurs. A cet effet, 4017 patients ambulatoires adultes dépressifs ont été suivis par des médecins généralistes et psychiatres dans toute la France pendant 6 semaines après prescription d'un traitement antidépresseur.
Abstract
Worsening of suicidal ideation during the first weeks of antidepressant treatment is a poorly understood phenomenon that prompted regulatory bodies to issue specific warnings. To better understand the causes of this phenomenon, this study compared the risk of suicidal ideation worsening in patients taking different types of antidepressant medications. To this aim, 4017 depressed adult outpatients were followed by general practitioners and psychiatrists throughout France for 6 weeks after prescription of an antidepressant treatment. The main study outcomes were to monitor changes (worsening or improvement) in suicidal ideation between baseline (treatment onset) and the study end (week 6) and to determine the remission rates according to the treatment type. Depression severity was assessed with the patient-administered Hospital Anxiety and Depression Scale and suicidal ideation with the 9-item Montgomery-Asberg Depression Rating Scale and the Hopelessness Scale. Use of tianeptine, a mu-opioid receptor agonist was significantly associated with a lower risk of suicidal ideation worsening compared with other antidepressants in the first 6 weeks of treatment. Conversely, remission rates were not significantly affected by the treatment type. Our results highlight a potential interest of opioid agonists to reduce the risk of worsening of suicidal ideation at antidepressant initiation.
KEYWORDS:
Antidepressants; Depression; Suicidal ideation; Suicide; Tianeptine; Treatment worsening suicidal ideation