Inadequacy of antidepressant treatment for patients with major depression who are at risk for suicidal behavior

Objective: The authors' goal was to determine whether suicide attempters wi th major depression received more intensive antidepressant treatment than d epressed patients who had not attempted suicide. Method: One hundred eighty inpatients who met DSM-III-R criteria for a major depressive episode accor ding to the Structured Clinical Interview for DSM-III-R were enrolled in th e study. All patients were assessed for lifetime history of suicide attempt s. Depressive symptoms at the index hospitalization were assessed with the Hamilton Depression Rating Scale and the Beck Depression Inventory. Strengt h of antidepressant treatment over the 90 days preceding the hospitalizatio n was scored by using the Antidepressant Treatment History Form. Results: A large majority of the depressed patients with a history of suicide attempt s, who were at higher risk for future suicide and suicide attempts, receive d inadequate treatment. Similarly, most of the depressed patients at lower risk for suicide attempts also received inadequate treatment. Conclusions: Major depression is undertreated pharmacologically, regardless of history o f suicide attempt. Some suicide attempts may be preventable if the problem of underdiagnosis and undertreatment of depression can be overcome by psych oeducation for health professionals and the public.