The clinical phenotype of major depression with suicidal ideation (MDD-SI)

by Novick, Danielle M., Ph.D., UNIVERSITY OF PITTSBURGH, 2010, 139 pages; 3435509


Our overall goal of this investigation was to broaden our understanding of MDD-SI. Specifically, we sought to document the associated features of MDD-SI, understand the phenomenology of MDD-SI, develop a clinical phenotype of MDD-SI, and discern whether the MDD-SI phenotype is associated with an unfavorable or differential initial response to treatment. We conceptualized this work as a preliminary investigation of the specific treatment needs of individuals with MDD-SI and potential identification of one subset of individuals who fail to experience an initial response to first-line monotherapies for major depression.

To this end, we completed a secondary analysis of data from a two-site, cross-national clinical trial in which individuals presenting in an episode of major depression were randomly allocated to an initial treatment protocol consisting of SSRI antidepressant pharmacotherapy (SSRI) or interpersonal psychotherapy (IPT).

In comparisons between individuals with MDD-SI and individuals without current, baseline suicidal ideation (MDD), we found that (1) few pre-treatment socio-demographic or baseline clinical characteristics significantly distinguished MDD-SI and MDD, (2) lifetime experiences of suicidal ideation and suicidal behavior were significantly different between MDD-SI and MDD, and (3) lifetime history and past month experiences of some mood and panic-agoraphobic spectrum symptoms were significantly different between MDD-SI and MDD. In addition, we demonstrated that MDD-SI is negatively associated with initial treatment response, such that individuals with MDD-SI were significantly more depressed after six weeks of treatment than were individuals with MDD. Nonetheless, after six weeks of treatment, interviewer-rated suicidal ideation resolved for over 90% of individuals with MDD-SI and self-reported suicidal ideation resolved for all but about 11%.

Our findings provide preliminary support for the usefulness of assessing both syndromal and subsyndromal manifestations of major depression, establishing a lifetime assessment of suicidality as routine clinical practice, and conceptualizing MDD-SI as a subtype and clinical phenotype of major depression. Further research, including replication of our findings, is needed.

AdviserEllen Frank
Source TypeDissertation
SubjectsClinical psychology
Publication Number3435509

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