Leo Sher, M.D.

Our research report, “Decreased suicidal ideation in depressed patients with or without comorbid posttraumatic stress disorder treated with selective serotonin reuptake inhibitors: an open study” was published 10 years ago in the April 2012 issue of Psychiatry Research (1). We have examined clinical parameters before and after three months of open selective serotonin reuptake inhibitors (SSRI) treatment of comorbid PTSD and MDD (PTSD-MDD) compared with MDD alone. Our hypothesis was that MDD only patients would show a greater degree of improvement with regard to symptoms of depression including suicidal ideation compared to the PTSD-MDD study participants based on a more modest burden of illness.

Ninety-six MDD patients were included in the study: 76 with MDD only and 20 with PTSD-MDD. Patients with psychotic features were excluded. At enrollment, all subjects were free of acute or serious medical illness. Clinical parameters were assessed before and after three months of open SSRI treatment.

At baseline, PTSD-MDD patients had higher Hamilton Depression Rating Scale and Buss-Durkee Hostility Scale scores compared with MDD only subjects. There was a significant decrease in scores on the Hamilton Depression Rating Scale, Beck Depression Inventory, Beck Hopelessness Scale, and Beck Scale for Suicidal Ideation after three months of treatment with SSRIs in both groups. The magnitude of improvement in Beck Scale for Suicidal Ideation scores was greater in the PTSD-MDD group compared to the MDD only subjects. Symptoms of depression including suicidal ideation improved in MDD patients with or without comorbid PTSD after 3 months of treatment with SSRIs but improvement in suicidal ideation was greater in the PTSD-MDD group.

Our finding has not supported the hypothesis that a response to treatment is poorer in the PTSD-MDD group which may indicate that sicker patients benefit more from treatment. Improvement of suicidal ideation scores with treatment is clinically important because suicidal ideation predicts suicidal behavior.

Reference

1. Sher L, Stanley BH, Posner K, Arendt M, Grunebaum MF, Neria Y, Mann JJ, Oquendo MA. Decreased suicidal ideation in depressed patients with or without comorbid posttraumatic stress disorder treated with selective serotonin reuptake inhibitors: an open study. Psychiatry Res. 2012 Apr 30;196(2-3):261-6. doi: 10.1016/j.psychres.2011.11.010. Epub 2012 Mar 6. PMID: 22397913; PMCID: PMC3361617.