Occurrence and Course of Suicidality During Short-term Treatment of Late-Life Depression
Abstract
BACKGROUND: Elderly persons (> or =65 years) have the highest rate of suicide; still, little is known about the occurrence, course, and responsivity of suicidal ideation during treatment of depression in late life and how suicidality affects treatment response. METHODS: This study was undertaken to determine (1) how suicidal ideation changes during short-term depression treatment and (2) whether treatment response differs among 3 groups of patients based on their levels of suicidality at baseline and during treatment (those with a recent suicide attempt or current suicidal ideation [high-risk group; n = 46], those with recurrent thoughts of death [moderate-risk group; n = 143], or those with no suicide attempt, suicidal ideation, or thoughts of death [low-risk group; n = 206]). This is a secondary analysis of pooled data from 3 treatment studies of late-life major depression. Participants were 395 elderly persons with a current major depressive episode, treated as inpatients or outpatients under protocolized conditions with paroxetine hydrochloride or nortriptyline hydrochloride, with or without interpersonal psychotherapy. Changes in suicidal ideation over time, rate of responses, and time to response in each group were compared. RESULTS: Suicidal ideation decreased rapidly early in the course of treatment, with more gradual change thereafter. At the beginning of treatment, 77.5% of the patients reported suicidal ideation, thoughts of death, or feelings that life is empty. After 12 weeks of treatment, suicidal ideation had resolved in all treated patients; 4.6% still reported thoughts of death. However, 6-week (P =.001) and 12-week (P =.02) rates of response were significantly lower in high-risk patients than in low- and moderate-risk patients. High- and moderate-risk patients needed a significantly (P<.001) longer time to respond than low-risk patients (median time to response, 6 and 5 vs 3 weeks). CONCLUSIONS: While suicidal ideation resolves rapidly, the resolution of thoughts about death is more gradual. Suicidal elderly persons with depression require special attention during depression treatment because they have a lower response rate and need a longer time to respond.
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Thoughts of suicide become less prominent or frequent when depression remits in older persons treated for depression.
“Thoughts of suicide become less prominent or frequent when depression remits in older persons who are treated for depression [12].”
From A systematic review of social factors and suicidal behavior in older adulthood (2012) · cites this paper as [12]
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The MMSE is not an adequate screening cognitive instrument in studies of late-life depression
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- Authors
- Szanto, K., Mulsant, B. H., Houck, P., Dew, M. A., & Reynolds, C. F.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2003-06-01
- Volume
- 60
- Issue
- 6
- Pages
- 610
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2096706538
- Cited by
- 179
- References
- 34
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 16 · 2020: 6 · 2019: 9 · 2018: 5 · 2017: 8 · 2016: 6 · 2015: 11 · 2014: 13 · 2013: 9 · 2012: 4
- FWCI
- 16.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (AG 05-133, P50AG005133)
- National Institute of Mental Health (K01MH001613, MH-52247, P30MH052247, MH-37869, K05MH000295, MH-43832, MH-01613, R01MH037869, K23MH070471)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- geriatric depression, suicidal ideation, suicide attempts, treatment response, paroxetine, nortriptyline, interpersonal psychotherapy, elderly patients, time to response
- MeSH terms
- Aged, Combined Modality Therapy, Major Depressive Disorder, Depressive Disorder, Female, Humans, Male, Nortriptyline, Psychotherapy, Risk Factors, Severity of Illness Index, Suicide, Suicide, Attempted, Time Factors, Treatment Outcome, Paroxetine
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