A naturalistic study of suicidal adolescents treated with an SSRI: suicidal ideation and behavior during 3-month post-hospitalization period

Asian J Psychiatr. 2014 Oct;11:13-9. doi: 10.1016/j.ajp.2014.03.014. Epub 2014 Apr 8.

Abstract

Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization.

Methods: One hundred twenty adolescents, who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication groups: SSRI antidepressant only (n=71); SSRI plus mood stabilizer (n=17); SSRI plus antipsychotic (n=20); and SSRI plus antipsychotic and mood stabilizer (n=12). Standardized instruments were used.

Results: Mean age=15.5±1.3, Caucasian=80.8%, female=74.2%, mean CDRS-R=61.7±12.1, suicide attempt during month prior to hospitalization=58.6%. During the 3-month post-hospitalization period: (1) there were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were associated with greater reduction in suicidal ideation at 3-months.

Conclusion: Declines in suicidal ideation, depression severity, and suicide attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify medication adherence is a study limitation.

Keywords: Adolescents; SSRI; Suicide.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / psychology
  • Female
  • Follow-Up Studies
  • Hospitalization*
  • Humans
  • Male
  • Risk Factors
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Severity of Illness Index
  • Suicidal Ideation*
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data*

Substances

  • Antidepressive Agents
  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors