SSRI versus bupropion effects on symptom clusters in suicidal depression: post
hoc analysis of a randomized clinical trial.
Author(s): Grunebaum MF(1), Keilp JG, Ellis SP, Sudol K, Bauer N, Burke AK, Oquendo MA, Mann
JJ.
Affiliation(s): Author information:
(1)Molecular Imaging and Neuropathology Division, New York State Psychiatric
Institute, 1051 Riverside Drive, Box 42, New York, NY 10032
mgruneb@nyspi.columbia.edu.
Publication date & source: 2013, J Clin Psychiatry. , 74(9):872-9
OBJECTIVE: Identifying the depression symptoms most closely associated with
suicidal thoughts and which medications provide the fastest depression relief may
help suicide prevention.
METHOD: Post hoc analysis of data from a randomized, double-blind, 8-week
clinical trial of the selective serotonin reuptake inhibitor paroxetine
controlled release (n = 36) versus the norepinephrine-dopamine reuptake inhibitor
bupropion extended release (n = 38) was conducted in patients with DSM-IV major
depressive disorder and past suicide attempt or current suicidal thoughts.
Treatment effects on Hamilton Depression Rating Scale (HDRS) and Beck Depression
Inventory symptom clusters were compared. We hypothesized that paroxetine would
demonstrate a superior effect on nonsuicidal, affective/cognitive depression
symptom clusters that our prior work found to be associated with suicidal
thoughts and attempts. Data were collected from February 2005 to January 2010.
RESULTS: There was a treatment main effect on HDRS psychic depression (depressed
mood, guilt, retardation, helpless, hopeless, worthless) (estimate = -2.2; 95%
CI, -3.2 to -1.1; t67.16 = -4.01; P < .001), one of the clusters most strongly
correlated to suicidal ideation. The net drug effect demonstrated that mean
psychic depression score was 2.2 points lower after 1 week of paroxetine compared
to bupropion treatment. The significance level of this effect was P < .001 at
weeks 1 and 2, P = .012 at week 3 and P = .051 at week 4. Results for other
depression scale factors were nonsignificant (P > .05).
CONCLUSIONS: The results require replication but suggest a pathway by which
selective serotonin reuptake inhibitor treatment may exert a stronger effect
compared with norepinephrine-dopamine reuptake inhibitor treatment on reduction
of suicidal thoughts during initial weeks of pharmacotherapy in these higher risk
patients.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00429169.
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