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Suicidal Thinking and Behavior During Treatment With Sertraline in Late-Life Depression

From the Department of Psychiatry, University of California San Francisco, San Franciso, CA (JCN, KD); and the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine and the Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA (LS).

Objective: To determine effects of sertraline on suicidal thinking and behavior in patients with late-life major depression.

Methods: This was a secondary analysis of an eight-week, placebo-controlled, double-blind randomized trial of a multicenter trial at 66 clinical sites. Outpatients 60 years of age with major depression and a Hamilton Depression Rating (HAMD) score 18 were included. Intervention was sertraline 50–100 mg/day or placebo for eight weeks. Measurements were 17-item HAMD administered at baseline and two-week intervals. HAMD Item 3 used to assess suicidal ideation (SI) and behavior. Reports of serious adverse events (SAEs), adverse events (AEs) leading to discontinuation, and spontaneously reported adverse events reviewed.

Results: A total of 747 patients received at least one dose of medication, and 728 had at least one posttreatment assessment. Mean age (±SD) was 69.8 ± 6.7 years (range: 59–97 years) and 56% were female. There were no completed suicides or suicide attempts during the double-blind trial. One SAE, hospitalization, was associated with SI in a patient on sertraline. No other AEs were associated with SI or behavior. HAMD Item 3 ratings progressively declined during the trial with significantly lower values for sertraline than placebo (Z = 2.41, p <0.02). In 248 patients with HAMD Item 3 of zero at baseline, the percentage of patients whose Item 3 ratings increased during treatment did not differ in the two groups (22.4% versus 25.8% for sertraline and placebo, respectively.)

Conclusion: Sertraline was associated with significantly lower HAMD Item 3 scores than placebo during treatment. There was no evidence of greater emergent suicidal thinking or behavior with sertraline than placebo.

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