Although antidepressant medications are effective in reducing depressive symptoms among adults, concerns recently have re-emerged that these medications may increase suicide risks during times of treatment initiation or dosage change. The FDA has issued a """"""""black box"""""""" warning for antidepressants when used by children and adolescents and advised close monitoring of patients of all ages when beginning or changing doses. Current FDA warnings are based on suicidal behaviors rather than completed suicide. However, these intermediate outcomes are often difficult to categorize and may not be on a complete continuum with completed suicide. Outcomes of treatment in the community may also differ from outcomes in controlled trials in which the use of adjunctive medications are sharply limited. We will use the VA National Registry for Depression (NARDEP), Medicare, and National Death Index data to examine the relationships between antidepressants, concomitant treatments, and completed suicide. NARDEP includes longitudinal data for over 1,500,000 patients diagnosed with depression from fiscal year (FY) 1997 forward, including data on demographics, health services use (from FY97 forward), and pharmacy use (from FY99 forward). Approximately 994,000 individuals will meet inclusion criteria for the proposed study, with over 2,800,000 person-years of data. We will evaluate potential differences in rates of suicide and suicide attempts among patients receiving: a) treatment with different antidepressant medication groups, b) treatment with four most commonly prescribed agents within the SSRI class and the three most commonly prescribed alternatives to SSRI agents, c) adjunctive agents used with antidepressants to augment treatment response, and d) supplemental hypnotic agents used with antidepressants to address insomnia. Study analyses will first use Cox-proportional hazards models with time-varying treatment exposures and covariates. We will also use Cox models with inverse probability of treatment weighting (IPTW) and instrumental variables to address potential treatment selection biases. In addition to the primary cohort analyses, we will conduct two nested case-control studies, using medical record data, to conduct a detailed assessment of potential selection biases that are not observable in the administrative data. These sub- studies will inform the cohort analyses and allow us to appropriately interpret study results. Clinicians, policymakers, and patients urgently need additional information about relative effectiveness of alternative depression treatments in reducing suicide. We anticipate that the proposed project will advance knowledge in this critical area and inform future efforts to use organizational datasets to examine sentinel events, such as suicide. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH078698-03
Application #
7437248
Study Section
Special Emphasis Panel (ZMH1-ERB-W (07))
Program Officer
Chambers, David A
Project Start
2006-08-01
Project End
2010-05-31
Budget Start
2008-06-01
Budget End
2010-05-31
Support Year
3
Fiscal Year
2008
Total Cost
$364,052
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Kim, Hyungjin Myra; Zivin, Kara; Choe, Hae Mi et al. (2015) Predictors of start of different antidepressants in patient charts among patients with depression. J Manag Care Spec Pharm 21:424-30
Pfeiffer, Paul N; Kim, Hyungjin M; Ganoczy, Dara et al. (2013) Treatment-resistant depression and risk of suicide. Suicide Life Threat Behav 43:356-65
Smith, Eric G; Kim, Hyungjin Myra; Ganoczy, Dara et al. (2013) Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. J Clin Psychiatry 74:226-32
Valenstein, Marcia; Kim, Hyungjin Myra; Ganoczy, Dara et al. (2012) Antidepressant agents and suicide death among US Department of Veterans Affairs patients in depression treatment. J Clin Psychopharmacol 32:346-53
Kim, Hyungjin Myra; Smith, Eric G; Stano, Claire M et al. (2012) Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Serv Res 12:18
Kim, Hyungjin Myra; Smith, Eric G; Ganoczy, Dara et al. (2012) Predictors of suicide in patient charts among patients with depression in the Veterans Health Administration health system: importance of prescription drug and alcohol abuse. J Clin Psychiatry 73:e1269-75
Smith, Eric G; Craig, Thomas J; Ganoczy, Dara et al. (2011) Treatment of Veterans with depression who died by suicide: timing and quality of care at last Veterans Health Administration visit. J Clin Psychiatry 72:622-9
Pfeiffer, Paul N; Ganoczy, Dara; Zivin, Kara et al. (2011) Benzodiazepines and adequacy of initial antidepressant treatment for depression. J Clin Psychopharmacol 31:360-4
Pfeiffer, Paul N; Valenstein, Marcia; Hoggatt, Katherine J et al. (2011) Electroconvulsive therapy for major depression within the Veterans Health Administration. J Affect Disord 130:21-5
Kim, Hyungjin Myra; Pfeiffer, Paul; Ganoczy, Dara et al. (2011) Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression. Psychiatr Serv 62:1346-52

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