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Lin WC, Su TP, Li CT, Wu HJ, Tsai SJ, Bai YM, Tu PC, Chen MH. Baseline cognitive function predicts full remission of suicidal symptoms among patients with treatment-resistant depression and strong suicidal ideation after low-dose ketamine infusion. J Psychopharmacol 2023; 37:795-801. [PMID: 37332247 DOI: 10.1177/02698811231182107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Whether pretreatment working memory and response inhibition function are associated with the rapid and sustained antisuicidal effect of low-dose ketamine among patients with treatment-resistant depression (TRD) and strong suicidal ideation is unclear. METHODS We enrolled 65 patients with TRD, comprising 33 who received a single infusion of 0.5 mg/kg ketamine and 32 who received a placebo infusion. The participants performed working memory and go/no-go tasks prior to infusion. We assessed suicidal symptoms at baseline and on postinfusion Days 2, 3, 5, and 7. RESULTS The full remission of suicidal symptoms persisted for 3 days after a single ketamine infusion and the ketamine-related antisuicidal effect persisted for 1 week. Lower cognitive impairment at baseline (indicated by a higher rate of correct responses on a working memory task) was associated with the rapid and sustained antisuicidal effect of low-dose ketamine in patients with TRD and strong suicidal ideation. DISCUSSION Patients with TRD and strong suicidal ideation but low cognitive impairment may benefit the most from the antisuicidal effect of low-dose ketamine.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
- Department of Medical Research, Taipei Veterans General Hospital, Taipei
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
| | - Hui-Ju Wu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Medical Research, Taipei Veterans General Hospital, Taipei
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei
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Choi M, Lee EH, Sempungu JK, Lee YH. Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study. Soc Sci Med 2023; 326:115926. [PMID: 37121069 DOI: 10.1016/j.socscimed.2023.115926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/16/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories. METHODS We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI). RESULTS We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory. CONCLUSIONS Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.
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Affiliation(s)
- Minjae Choi
- Institute for Future Public Health, Graduate School of Public Health, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Eun Hae Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, the Republic of Korea
| | - Joshua Kirabo Sempungu
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, the Republic of Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.
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Bloomfield-Clagett B, Greenstein DK, Kush JM, Musci R, Zarate CA, Ballard ED. Predictors of suicidal ideation trajectories in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. J Psychiatr Res 2022; 148:9-13. [PMID: 35085929 PMCID: PMC8961701 DOI: 10.1016/j.jpsychires.2022.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 12/28/2022]
Abstract
A better understanding of suicidal ideation (SI), including patterns of SI, may help elucidate links between depression, SI, and suicidal behavior. This study sought to identify trajectories of SI in a large, community-based clinical trial of participants with major depressive disorder (MDD) and to investigate the relationships between these trajectories and predictors of interest, including anxiety and anhedonia. A longitudinal latent class analysis was conducted in 3923 participants enrolled in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study of citalopram for the treatment of MDD. An unconditional latent class analysis was conducted using SI at study weeks 0, 2, 4, 6, and 9 as the indicators. A multinomial regression was then conducted with SI trajectory as the outcome and anhedonia, severity of depressive symptoms, atypical depression, anxiety, history of suicide attempt, history of substance abuse, history of trauma, and other covariates as the predictors. Four SI trajectories were identified: 1) variable SI; 2) little-to-no SI; 3) persistent SI; and 4) improving SI. Compared to the little-to-no SI trajectory, those with more severe anhedonia were more likely to experience persistent SI, while those with more severe anxiety were more likely to experience improving SI. Factors that distinguish SI trajectories, such as anxiety and anhedonia, may be critical targets for intervention or profiles for prognosis.
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Affiliation(s)
- Bartholt Bloomfield-Clagett
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Dede K. Greenstein
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Joseph M. Kush
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D. Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Nobile B, Olié E, Dubois J, Guillaume S, Gorwood P, Courtet P. Characteristics and treatment outcome of suicidal depression: Two large naturalistic cohorts of depressed outpatients. Aust N Z J Psychiatry 2022; 56:347-364. [PMID: 34281409 DOI: 10.1177/00048674211025697] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The emergence of new drugs for managing suicidal ideation (e.g. ketamine) raises the question of whether suicidal depression (i.e. moderate to severe depression with concomitant suicidal ideation) is a specific depression phenotype. Therefore, this study characterized patients with suicidal depression (baseline clinical characteristics, suicidal ideation and depression evolutions, suicide risk) in two large cohorts of outpatients with depression. METHODS LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with depression (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria), treated and followed up for 6 weeks. Depression severity was assessed with the Hospital Anxiety and Depression Scale, and suicidal ideation with the suicidal item of the Montgomery-Åsberg Depression Rating Scale. Patients with moderate or severe depression (Hospital Anxiety and Depression Scale-Depression subscale score >11) were selected and classified as without suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale <2), with moderate suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale [2; 3]) and with severe suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale ⩾4). RESULTS Baseline clinical features were more severe (e.g. higher anxiety and depression scores) in depressed patients with moderate/severe suicidal ideation. Depression remission after treatment was less frequent among patients with severe suicidal ideation. The risk of suicide attempt during the follow-up was threefold higher in patients with suicidal ideation among those 10% had persistent suicidal ideation. CONCLUSION Suicidal depression could be a specific depression phenotype with more severe clinical characteristics, less frequent depression remission, suicidal ideation persistence and higher suicide attempt risk, despite antidepressant treatment. It seems that novel therapeutic strategies could be needed.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philip Gorwood
- Inserm UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
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Stumps A, Jagger-Rickels A, Rothlein D, Amick M, Park H, Evans T, Fortenbaugh FC, Fortier CB, Fonda JR, Lee D, Milberg W, McGlinchey R, DeGutis J, Esterman M. Connectome-based functional connectivity markers of suicide attempt. J Affect Disord 2021; 283:430-440. [PMID: 33549365 DOI: 10.1016/j.jad.2020.11.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/23/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional brain markers of suicidality can help identify at-risk individuals and uncover underlying neurocognitive mechanism(s). Although some converging evidence has implicated dysfunction in several brain networks, suicide-related neuroimaging markers are inconsistent across studies, due to heterogeneity of neuroimaging approaches, clinical populations, and experimental methods. METHODS The current study aimed to address these limitations by examining resting-fMRI connectivity in a sample of post-9/11 veterans with a past suicide attempt (SA; n = 16) compared to a psychiatric control group (PC; n = 124) with no SA history but comparable past and present symptomatology, as well as a trauma control group (TC; n = 66) of trauma-exposed healthy controls. We used both a novel graph-analytic and seed-based approach to characterize SA-related connectivity differences across brain networks. RESULTS First, the graph-analytic approach identified the right amygdala and a region in the cognitive control network (right middle temporal gyrus; MTG) as regional SA-related hubs of dysfunction (HoD), or regions that exhibited a high number of SA-related connections. Aberrant SA-related connectivity between these hubs spanned multiple networks, including the cognitive control, default mode and visual networks. Second, the seed-based connectivity analysis that identifies SA-related differences in the strength of neural connections across the whole brain further implicated the right amygdala. LIMITATIONS Small sample size and potential underreporting of SA. CONCLUSIONS These two analytic approaches preliminarily suggest that the right amygdala and right MTG may be specific neural markers of SA that can be differentiated from neural markers of psychopathology more broadly.
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Affiliation(s)
- Anna Stumps
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Audreyana Jagger-Rickels
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Rothlein
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA
| | - Melissa Amick
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Hannah Park
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Travis Evans
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Francesca C Fortenbaugh
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Daniel Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, 02130, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, 02130, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael Esterman
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, 02130, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA 02130, USA; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, 02130, USA; Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.
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