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Suicidal events in the Treatment for Adolescents With Depression Study (TADS).

Publication ,  Journal Article
Vitiello, B; Silva, SG; Rohde, P; Kratochvil, CJ; Kennard, BD; Reinecke, MA; Mayes, TL; Posner, K; May, DE; March, JS
Published in: The Journal of clinical psychiatry
April 2009

The Treatment for Adolescents with Depression Study (TADS) database was analyzed to determine whether suicidal events (attempts and ideation) occurred early in treatment, could be predicted by severity of depression or other clinical characteristics, and were preceded by clinical deterioration or symptoms of increased irritability, akathisia, sleep disruption, or mania.TADS was a 36-week randomized, controlled clinical trial of pharmacologic and psychotherapeutic treatments involving 439 youths with major depressive disorder (DSM-IV criteria). Suicidal events were defined according to the Columbia Classification Algorithm of Suicidal Assessment. Patients were randomly assigned into the study between spring 2000 and summer 2003.Forty-four patients (10.0%) had at least 1 suicidal event (no suicide occurred). Events occurred 0.4 to 31.1 weeks (mean +/- SD = 11.9 +/- 8.2) after starting TADS treatment, with no difference in event timing for patients receiving medication versus those not receiving medication. Severity of self-rated pretreatment suicidal ideation (Suicidal Ideation Questionnaire adapted for adolescents score > or = 31) and depressive symptoms (Reynolds Adolescent Depression Scale score > or = 91) predicted occurrence of suicidal events during treatment (P < .05). Patients with suicidal events were on average still moderately ill prior to the event (mean +/- SD Clinical Global Impressions-Severity of Illness scale score = 4.0 +/- 1.3) and only minimally improved (mean +/- SD Clinical Global Impressions-Improvement scale score = 3.2 +/- 1.1). Events were not preceded by increased irritability, akathisia, sleep disturbance, or manic signs. Specific interpersonal stressors were identified in 73% of cases (N = 44). Of the events, 55% (N = 24) resulted in overnight hospitalization.Most suicidal events occurred in the context of persistent depression and insufficient improvement without evidence of medication-induced behavioral activation as a precursor. Severity of self-rated suicidal ideation and depressive symptoms predicted emergence of suicidality during treatment. Risk for suicidal events did not decrease after the first month of treatment, suggesting the need for careful clinical monitoring for several months after starting treatment.

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Published In

The Journal of clinical psychiatry

DOI

EISSN

1555-2101

ISSN

0160-6689

Publication Date

April 2009

Volume

70

Issue

5

Start / End Page

741 / 747

Related Subject Headings

  • Surveys and Questionnaires
  • Suicide
  • Sleep Wake Disorders
  • Selective Serotonin Reuptake Inhibitors
  • Psychomotor Agitation
  • Psychiatry
  • Male
  • Irritable Mood
  • Humans
  • Fluoxetine
 

Citation

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Vitiello, B., Silva, S. G., Rohde, P., Kratochvil, C. J., Kennard, B. D., Reinecke, M. A., … March, J. S. (2009). Suicidal events in the Treatment for Adolescents With Depression Study (TADS). The Journal of Clinical Psychiatry, 70(5), 741–747. https://doi.org/10.4088/jcp.08m04607
Vitiello, Benedetto, Susan G. Silva, Paul Rohde, Christopher J. Kratochvil, Betsy D. Kennard, Mark A. Reinecke, Taryn L. Mayes, Kelly Posner, Diane E. May, and John S. March. “Suicidal events in the Treatment for Adolescents With Depression Study (TADS).The Journal of Clinical Psychiatry 70, no. 5 (April 2009): 741–47. https://doi.org/10.4088/jcp.08m04607.
Vitiello B, Silva SG, Rohde P, Kratochvil CJ, Kennard BD, Reinecke MA, et al. Suicidal events in the Treatment for Adolescents With Depression Study (TADS). The Journal of clinical psychiatry. 2009 Apr;70(5):741–7.
Vitiello, Benedetto, et al. “Suicidal events in the Treatment for Adolescents With Depression Study (TADS).The Journal of Clinical Psychiatry, vol. 70, no. 5, Apr. 2009, pp. 741–47. Epmc, doi:10.4088/jcp.08m04607.
Vitiello B, Silva SG, Rohde P, Kratochvil CJ, Kennard BD, Reinecke MA, Mayes TL, Posner K, May DE, March JS. Suicidal events in the Treatment for Adolescents With Depression Study (TADS). The Journal of clinical psychiatry. 2009 Apr;70(5):741–747.

Published In

The Journal of clinical psychiatry

DOI

EISSN

1555-2101

ISSN

0160-6689

Publication Date

April 2009

Volume

70

Issue

5

Start / End Page

741 / 747

Related Subject Headings

  • Surveys and Questionnaires
  • Suicide
  • Sleep Wake Disorders
  • Selective Serotonin Reuptake Inhibitors
  • Psychomotor Agitation
  • Psychiatry
  • Male
  • Irritable Mood
  • Humans
  • Fluoxetine