About 33% of people with major depressive disorder (MDD) who are in remission continue to experience suicidal symptoms even when the worst has subsided. This is one of the findings from an analysis published in Psychiatric Research.

MDD accounts for between 59% and 87% of all suicides. MDD also ebbs and flows, with about 80% of patients with MDD experiencing at least 5 recurrences. While suicidal symptoms may also re-appear, they don’t always lead to action. “While depression predicts suicidal ideation, it does not predict suicidal behavior, and the majority of depressed people do not engage in suicidal behaviors,” the researchers made clear.

Although MDD and suicidal thoughts and behavior are closely related, few studies have explored suicidal symptoms in connection with recurrent, remissive MDD. The researchers wanted to study the presence of suicidal symptoms in people with recurrent depression as well as whether suicidal symptoms relate to recurrence.


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The researchers recruited participants from the Depression Evaluation Longitudinal Therapy Assessment (DELTA)-study and other methods. They recruited 73 patients with MDD and 45 controls. Not all participants from the MDD group completed all of the follow-ups.

From there, they assessed suicidal symptoms. They used a cohort design to monitor recurrences every 3 to 4 months over 2.5 years.

The researchers found the MDD group participants who self-reported experienced higher levels of depressive symptoms during remission than the control group. Self-reported suicide symptoms were also higher (28% vs 2.3%). The researchers found no significant difference in the clinician-reported symptoms (6.9% vs 2.2%).

The researchers also found higher suicidal symptoms were associated with higher depressive symptoms over 2.5 years. None of the participants used antidepressants during the entire study period. A total of 3 participants used antidepressants when they experienced a recurrence.

Although the researchers recruited a specific cohort with recurrent, remittent symptoms, they note that the study could be limited by assessment. They used a depression scale rather than a suicide ideation scale. The researchers also aren’t sure whether rating “I feel that life is empty or wonder if it’s worth living” relates to depression or suicidal thoughts.

“We think that these findings might contribute to a better characterization of MDD patients at risk for recurrence,” the researchers said. “We recommend to closely monitor suicidal symptoms during MDD remission, preferably including self-reported questionnaires apart from clinician-based assessments. Increases of self-reported suicidal ideation and/or behavior might be indicative for impeding relapse.”

Reference

Heuschen CBBCM, Mocking RJT, Zantvoord JB, et al. Suicidal ideation in remitted major depressive disorder predicts recurrence. J. Psychiatr. Res. 2022;151:65-72. doi:10.1016/j.jpsychires.2022.04.005