0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Dr. Oquendo and Colleagues Reply
MARIA A. OQUENDO, M.D.; ANDRES BARRERA, M.D.; STEVEN P. ELLIS, Ph.D.; SHUHUA LI, M.D.; AINSLEY K. BURKE, Ph.D.; MICHAEL GRUNEBAUM, M.D.; JEAN ENDICOTT, Ph.D.; J. JOHN MANN, M.D.
Am J Psychiatry 2005;162:403-a-404. doi:10.1176/appi.ajp.162.2.403-a

To the Editor: We thank Drs. Allen and Chessick for their comments. Although there are similarities in the clinical presentation of bipolar depression and unipolar depression, neurobiological evidence from neuroimaging (1) and genetic studies (2) lends credence to the notion that unipolar and bipolar disorders are not the same. Thus, their data and ours are difficult to compare.

Nonetheless, they raise interesting points. They suggest an interaction between attempter status and predictors of suicidal ideation, with "anxiety, depression, and neuroticism" predicting suicidal ideation in nonattempters and "temperamental behavior, poor role functioning, and negative life events" predicting suicidal ideation among past attempters. This may well be the case, but is a different question from the one we examined in our article, namely, whether depressive symptoms are similar within subjects but across different episodes. The prediction of suicidal behavior is the focus of a recently published report in which we found that a history of suicide attempts, which was present in half of that group of depressed patients, predicts future suicidal behavior, as do pessimism and aggression/impulsivity (3).

The role of anxiety and depression in suicidal behavior appears to be complex. Some investigators found an association between anxiety and suicidal behavior in depressed individuals (4). We have previously reported that anxiety symptoms during a major depressive episode, and the presence of panic disorder that was comorbid with a major depressive episode in particular, appear to protect individuals against suicidal behavior (5). This is in agreement with the clinical presentation of anxious or panic disorder patients who often are fearful that their anxiety symptoms signal impending death. These patients hardly appear to embrace their own demise as a solution to their problems. However, anxiety disorders cover a wide spectrum of clinical presentations, and we have also reported that posttraumatic stress disorder (PTSD) increases the risk of suicidal behavior (6). Indeed, in a recent work describing a mostly independent sample (7), we replicated this finding but found that the association between PTSD and suicidal acts was related to the frequent comorbidity of cluster B personality disorders in depressed patients with PTSD. Thus, not all anxiety disorders are the same in terms of their relationship with suicidal acts.

For the current article, we examined our data in detail to determine whether anxiety and suicidal ideation were inversely related within or across episodes of depression in patients with major depressive disorder. We could find no evidence for this or for the opposite relationship, although, clearly, our measures of both anxiety and suicidal ideation were limited. We compared only the ratings on the Hamilton Depression Rating Scale, as was the goal of our article. Thus, an examination of anxiety and suicidal behavior, such as the ones we previously reported, may have yielded different results. Moreover, the relationship between suicidal behavior and anxiety may differ in unipolar and bipolar depression. This would not be totally surprising, given the fact that suicidal behavior is almost twice as common in bipolar disorder as in major depressive disorder (811), further underscoring the fact that these two disorders are different entities that share some commonalities.

Phillips ML, Drevets WC, Rauch SL, Lane R: Neurobiology of emotion perception, II: implications for major psychiatric disorders. Biol Psychiatry  2003; 54:515–528
[PubMed]
[CrossRef]
 
DePaulo JR Jr: Genetics of bipolar disorder: where do we stand? (editorial). Am J Psychiatry  2004; 161:595–597
[PubMed]
[CrossRef]
 
Oquendo MA, Galfalvy H, Russo S, Ellis SP, Grunebaum MF, Burke A, Mann JJ: Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. Am J Psychiatry  2004; 161:1433–1441
[PubMed]
[CrossRef]
 
Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, Gibbons R: Time-related predictors of suicide in major affective disorder. Am J Psychiatry  1990; 147:1189–1194
[PubMed]
 
Placidi GPA, Oquendo MA, Malone KM, Brodsky B, Ellis SP, Mann JJ: Anxiety in major depression: relationship to suicide attempts. Am J Psychiatry  2000; 157:1614–1618
[PubMed]
[CrossRef]
 
Oquendo MA, Friend JM, Halberstam B, Brodsky BS, Burke AK, Grunebaum MF, Malone KM, Mann JJ: Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry  2003; 160:580–582
[PubMed]
[CrossRef]
 
Oquendo MA, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, Zelazny J, Burke AK, Firinciogullari S, Ellis SP, Mann JJ: Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry (in press)
 
Bostwick JM, Pankratz VS: Affective disorders and suicide risk: a reexamination. Am J Psychiatry  2000; 157:1925–1932
[PubMed]
[CrossRef]
 
Chen Y-W, Dilsaver SC: Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders. Biol Psychiatry  1996; 39:896–899
[PubMed]
[CrossRef]
 
Goodwin FK, Jamison KR: Suicide in Manic-Depressive Illness. New York, Oxford University Press, 1990
 
Sharma R, Markar HR: Mortality in affective disorder. J Affect Disord  1994; 31:91–96
[PubMed]
[CrossRef]
 
+

References

Phillips ML, Drevets WC, Rauch SL, Lane R: Neurobiology of emotion perception, II: implications for major psychiatric disorders. Biol Psychiatry  2003; 54:515–528
[PubMed]
[CrossRef]
 
DePaulo JR Jr: Genetics of bipolar disorder: where do we stand? (editorial). Am J Psychiatry  2004; 161:595–597
[PubMed]
[CrossRef]
 
Oquendo MA, Galfalvy H, Russo S, Ellis SP, Grunebaum MF, Burke A, Mann JJ: Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. Am J Psychiatry  2004; 161:1433–1441
[PubMed]
[CrossRef]
 
Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, Gibbons R: Time-related predictors of suicide in major affective disorder. Am J Psychiatry  1990; 147:1189–1194
[PubMed]
 
Placidi GPA, Oquendo MA, Malone KM, Brodsky B, Ellis SP, Mann JJ: Anxiety in major depression: relationship to suicide attempts. Am J Psychiatry  2000; 157:1614–1618
[PubMed]
[CrossRef]
 
Oquendo MA, Friend JM, Halberstam B, Brodsky BS, Burke AK, Grunebaum MF, Malone KM, Mann JJ: Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry  2003; 160:580–582
[PubMed]
[CrossRef]
 
Oquendo MA, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, Zelazny J, Burke AK, Firinciogullari S, Ellis SP, Mann JJ: Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry (in press)
 
Bostwick JM, Pankratz VS: Affective disorders and suicide risk: a reexamination. Am J Psychiatry  2000; 157:1925–1932
[PubMed]
[CrossRef]
 
Chen Y-W, Dilsaver SC: Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other axis I disorders. Biol Psychiatry  1996; 39:896–899
[PubMed]
[CrossRef]
 
Goodwin FK, Jamison KR: Suicide in Manic-Depressive Illness. New York, Oxford University Press, 1990
 
Sharma R, Markar HR: Mortality in affective disorder. J Affect Disord  1994; 31:91–96
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
APA Practice Guidelines > Chapter 0.  >
Textbook of Psychotherapeutic Treatments > Chapter 6.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 53.  >
APA Practice Guidelines > Chapter 0.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 31.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles