Hopelessness and suicidal ideation in outpatients with treatment-resistant depression

Prevalence and impact on treatment outcome

George I. Papakostas, Timothy Petersen, Joel Pava, Ella Masson, John J. Worthington, Jonathan E. Alpert, Maurizio Fava, Andrew A. Nierenberg

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact of suicidal ideation and hopelessness on treatment with nortriptyline (NT). The degree of suicidal ideation and hopelessness was assessed during the screen visit with the use of items #3 and #30 of the Hamilton Depression Rating Scale (HAM-D) in 89 patients with TRD who entered a 6-week open trial of NT. Forty of these patients also completed the Beck Hopelessness Index (BHI) during the screen visit. In separate logistic regressions, the scores from the BHI and the two HAM-D items were then tested as predictors of clinical response to the 6-week trial with NT, controlling for the severity of depression. More than half of patients reported thoughts or wishes of death to self and significant hopelessness. A greater degree of hopelessness before treatment in completers, reflected by the score on the HAM-D item #30, predicted response to NT. More than half of patients with prominent hopelessness who completed the trial responded. Patients with TRD are more likely than not to report prominent suicidal ideation and hopelessness. Furthermore, a full 6-week trial of NT, a relatively noradrenergic tricyclic antidepressant, may be particularly useful in patients who have failed to respond to several antidepressants and also report significant hopelessness.

Original languageEnglish (US)
Pages (from-to)444-449
Number of pages6
JournalJournal of Nervous and Mental Disease
Volume191
Issue number7
StatePublished - Jul 1 2003
Externally publishedYes

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Treatment-Resistant Depressive Disorder
Suicidal Ideation
Nortriptyline
Outpatients
Depression
Tricyclic Antidepressive Agents
Suicide
Antidepressive Agents
Logistic Models
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Papakostas, G. I., Petersen, T., Pava, J., Masson, E., Worthington, J. J., Alpert, J. E., ... Nierenberg, A. A. (2003). Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: Prevalence and impact on treatment outcome. Journal of Nervous and Mental Disease, 191(7), 444-449.

Hopelessness and suicidal ideation in outpatients with treatment-resistant depression : Prevalence and impact on treatment outcome. / Papakostas, George I.; Petersen, Timothy; Pava, Joel; Masson, Ella; Worthington, John J.; Alpert, Jonathan E.; Fava, Maurizio; Nierenberg, Andrew A.

In: Journal of Nervous and Mental Disease, Vol. 191, No. 7, 01.07.2003, p. 444-449.

Research output: Contribution to journalArticle

Papakostas, GI, Petersen, T, Pava, J, Masson, E, Worthington, JJ, Alpert, JE, Fava, M & Nierenberg, AA 2003, 'Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: Prevalence and impact on treatment outcome', Journal of Nervous and Mental Disease, vol. 191, no. 7, pp. 444-449.
Papakostas, George I. ; Petersen, Timothy ; Pava, Joel ; Masson, Ella ; Worthington, John J. ; Alpert, Jonathan E. ; Fava, Maurizio ; Nierenberg, Andrew A. / Hopelessness and suicidal ideation in outpatients with treatment-resistant depression : Prevalence and impact on treatment outcome. In: Journal of Nervous and Mental Disease. 2003 ; Vol. 191, No. 7. pp. 444-449.
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