References pertaining to depression and suicide risk:

J Clin Psychiatry. 2001;62 Suppl 25:27-30.

Mood disorders and suicide.

Nierenberg AA, Gray SM, Grandin LD.

Bipolar Programs, Massachusetts General Hospital, Boston 02114, USA. Anierenberg@partners.org

The mood disorders unipolar major depression and bipolar disorder increase the risk of suicidal ideation, attempted suicide, and death by completed suicide. This article reviews the epidemiologic data on the relationship between mood disorders and suicide, with an emphasis on the substantial risk of suicide, while reassessing older data that may no longer apply. Widespread underdiagnosis and undertreatment of major depression and bipolar disorder contribute to an unacceptable risk of suicide, a preventable tragedy.

Publication Types:
Review

PMID: 11765092 [PubMed - indexed for MEDLINE]

Am J Manag Care. 2001 Sep;7(11 Suppl):S353-66.

Current perspectives on the diagnosis and treatment of major depressive disorder.

Nierenberg AA.

Each year in America approximately 6 million people suffer from depression at a cost of more than $16 billion. People who are depressed have more medical illnesses than those without depression and make greater use of healthcare services. In a 15-month period after having been diagnosed with depression, sufferers are 4 times more likely to die as those who do not have depression. Almost 60% of suicides have their roots in major depression, and 15% of those admitted to a psychiatric hospital for depression eventually kill themselves. Although depression is highly treatable, only one third of sufferers receive suitable treatment. The reason for underdiagnosis is 2-fold. Physicians may fail to recognize depression and sufferers may actively deny it. A family history of depression is an important cause in those who suffer recurrent episodes. Major depressive disorder is the most common type of depression and, unless treated, resolves by itself in 6 months to a year less than 40% of the time. Depressive symptoms can be found in as many as 30% of those who abuse alcohol, so abstinence is crucial to treatment. Contrary to popular belief, depression is not a normal part of aging, although it can occur in elderly people who have severe medical and psychosocial problems. The goal of pharmacotherapy is the reduction and ultimate removal of all signs and symptoms of depression. More than 2 dozen drugs with 7 distinct mechanisms of action are available to treat depression, with the clinical goal being remission. Whereas psychotherapy is a treatment option, by itself it tends to be effective in only a limited group of highly motivated individuals who have less severe forms of depression. As a result, treatment outcomes are better when pharmacologic antidepressant treatment and psychotherapy are combined.

Publication Types:
Review

PMID: 11570026 [PubMed - indexed for MEDLINE]

J Clin Psychiatry. 1999;60 Suppl 2:57-62; discussion 75-6, 113-6.

Suicide risk in patients with major depressive disorder.

Angst J, Angst F, Stassen HH.

Zurich University Psychiatric Hospital, Switzerland. nthommen@bli.unizh.ch

Understanding the origins of suicide is the first step in preventing it. Review of the current literature has revealed only limited data from general practice and community samples; most research has been performed on inpatient psychiatric populations, and extended follow-ups are rare. Mood disorders were found to be highly associated with suicide, especially in patients with major depressive disorder. Depression is an important factor in suicides of adolescents and the elderly, but those with late-onset depression are at higher risk. Both comorbidity with other disorders, such as anxiety and agitation, and rapid changes in the depressive state, for instance after release from the hospital, increase the risk for suicide.

Psychiatr Clin North Am. 1997 Sep;20(3):499-517.

Identification of suicide risk factors using epidemiologic studies.

Moscicki EK.

Prevention and Behavioral Medicine Research Branch, National Institute of Mental Health, National Institutes of Health, Rockville, Maryland, USA.

Suicide is a complex outcome of multiple, inter-related factors. This article presents the epidemiology of completed and attempted suicide and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Mental and addictive disorders, frequently in co-occurrence, are the most powerful risk factors for suicide in all age groups, accounting for over 90 percent of all completed suicides. In combination with proximal risk factors such as access to firearms or other lethal means, recent and severe stressful life events, and intoxication, they can form the necessary and sufficient conditions for suicide.

Publication Types:
Review

Depress Anxiety. 1997;5(4):202-11.

Suicide: risk factors and prevention in refractory major depression.

Oquendo MA, Malone KM, Mann JJ.

Department of Neuroscience, New York State Psychiatric Institute, NY 10032, USA.

The literature regarding risk factors for suicidal behavior in the context of major depressive episode is reviewed. An organized framework for prevention strategies is provided. Risk factors for suicide in major depression can be organized according to whether their effect is on the threshold for suicidal acts or whether they serve mainly as triggers or precipitants of suicidal acts. For patients sufficiently depressed to present for evaluation and treatment, severity of depression is a poor guide to risk for suicidal acts. The best predictors relate to the threshold or predisposition to suicidal acts in response to major depression. Although available literature on suicidal behavior focuses on major depression in general, the findings may be usefully applied in refractory depression. Guidelines for assessment and management of suicidal behavior in major depression are offered.

Publication Types:
Review

PMID: 9338112 [PubMed - indexed for MEDLINE]