Does early improvement in major depression protect against treatment emergent suicidal ideation?

Objective To investigate the association of early improvement and treatment emergent suicidal ideation in a large sample ( N = 705) of naturalistically treated inpatients with major depressive disorder. Method In line with previous reports early improvement was defined as a 20% HAMD improvement within the first two weeks of antidepressant treatment. Treatment emergent suicidal ideation was defined by a sudden increase from 0 or 1 to at least 3 on HAMD item 3 and from 0.1 to at least 4 on MADR item 10 for suicidal ideation. Early improvers were compared with non-early improvers with respect to the occurrence of treatment emergent suicidality during treatment. Results Early improvers were 3 (MADRS) to 3.4 (HAMD) times less likely to experience new emergence of suicidal ideation during the treatment course than non-improvers. In addition, early improvement was associated with significantly less pessimistic thoughts. Limitations The analysis is based on secondary analysis of prospectively collected data. No controlled study design. Conclusion Early improvement is associated with significantly less treatment emergent suicidal ideation for it may provide rapid symptom relief and reduce hopelessness.