Objective: Relationships between antidepressant treatment and suicidality remain uncertain in major depressive disorder (MDD), and rarely evaluated in bipolar disorder (BPD).
Method: We evaluated changes in suicidality ratings (Hamilton Depression Rating Scale item-3) at the start and after 3.59 ± 2.57 months of sustained antidepressant treatment in a systematically assessed clinical sample (n = 789) of 605 patients with MDD, 103 patients with BPD-II and 81 patients with BPD-I (based on DSM-IV; 68.1% women; aged 44.3 ± 16.1 years), comparing suicidal vs. non-suicidal and recovered vs. unrecovered initially suicidal patients.
Results: Suicidal patients (103/789, 16.5%; BPD/MDD risk: 2.2) were more depressed and were ill longer. During treatment, 81.5% of suicidal patients became non-suicidal; 0.46% of 656 initially non-suicidal patients reported new suicidal thoughts, with no new attempts. Becoming non-suicidal was associated with greater depression severity and greater improvement.
Conclusion: Suicidal ideation was prevalent in patients with depressed major affective disorder, but most of the initially suicidal patients became non-suicidal with antidepressant treatment, independent of diagnosis, treatment type or dose.