TY  - JOUR
PY  - 2009//
TI  - Predictors of Spontaneous and Systematically Assessed Suicidal Adverse Events in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study
JO  - American journal of psychiatry
A1  - Brent, David A.
A1  - Emslie, G. J.
A1  - Clarke, Greg N.
A1  - Asarnow, Joan
A1  - Spirito, Anthony
A1  - Ritz, Louise
A1  - Vitiello, Benedetto
A1  - Iyengar, Satish
A1  - Birmaher, B.
A1  - Ryan, Neal D.
A1  - Zelazny, Jamie M.
A1  - Onorato, Matthew
A1  - Kennard, Betsy
A1  - Mayes, Taryn L.
A1  - DeBar, Lynn L.
A1  - McCracken, J. T.
A1  - Strober, Michael
A1  - Suddath, Robert
A1  - Leonard, H.
A1  - Porta, Giovanna
A1  - Keller, M. B.
SP  - 418
EP  - 426
VL  - 166
IS  - 4
N2  - Objective The authors sought to identify predictors of self-harm adverse events in treatment-resistant, depressed adolescents during the first 12 weeks of treatment. Method Depressed adolescents (N=334) who had not responded to a previous trial with an SSRI antidepressant were randomized to a switch to either another SSRI or venlafaxine, with or without cognitive behavior therapy. Self-harm events, i.e., suicidal and non-suicidal self-injury adverse events were assessed by spontaneous report for the first 181 participants, and by systematic weekly assessment for the last 153 participants. Results Higher rates of suicidal (20.8% vs. 8.8%) and nonsuicidal self-injury (17.6% vs. 2.2%), but not serious adverse events (8.4% vs. 7.3%) were detected with systematic monitoring. Median time to a suicidal event was 3 weeks, predicted by high baseline suicidal ideation, family conflict, and drug and alcohol use. Median time to nonsuicidal self-injury was 2 weeks, predicted by previous history of nonsuicidal self-injury. While there were no main effects of treatment, venlafaxine treatment was associated with a higher rate of self-harm adverse events in those with higher suicidal ideation. Adjunctive use of benzodiazepines, while in a small number of participants (N=10) was associated with higher rate of both suicidal and nonsuicidal self-injury adverse events. Conclusions Since predictors of suicidal adverse events also predict poor response to treatment, and many of these events occurred early in treatment, improving the speed of response to depression, by targeting of family conflict, suicidal ideation, and drug use may help to reduce their incidence. The relationship of venlafaxine and of benzodiazepines to self-harm events requires further study and clinical caution.<p />  <p>Language: en</p>
LA  - en
SN  - 0002-953X
UR  - http://dx.doi.org/10.1176/appi.ajp.2008.08070976
ID  - ref1
ER  -