April 14, 2012
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A while back, I cam across an interesting study published in the American Journal of Psychiatry. Bridge et. al. (2005) looked at the number of new cases of emergent suicidality during a clinical psychotherapy trial for depression in adolescents and what important predictors were at play. Emergent suicidality can be defined as an increase in the rate of suicide, suicidal attempts, preparation for suicide and suicidal thoughts during the early stages of treatment, although definitions sometimes varies across studies (Meyer et. al. 2010).
The general message of the Bridge et. al. study was that the rate of emergent suicidality in the drug-free psychotherapy trial was 12.5% (this was not attributable to the therapy itself). They also found that the strongest predictor of emergent suicidality was the level of self-reported suicidal thoughts at the baseline rather than what was recorded during the intake interview. So the more suicidal thoughts you have at the start of psychotherapy, the more likely you are to experience suicidality during the psychotherapy treatment.
In this clinical trial, which enrolled subjects similar to those enrolled in pharmacotherapy clinical trials, rates of emergent suicidality in patients receiving psychotherapy but no pharmacotherapy were comparable to rates observed in antidepressant trials. Self-reported suicidality in the week before intake predicted the onset of emergent suicidality to a much greater extent than did interview-rated suicidality, indicating that self-report may be a necessary component to the assessment of adolescent suicidal risk.
This is an important finding, because it casts a shadow of doubt over studies purporting to show an increase level of suicidality during treatment with antidepressants. Read more of this post