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Suicide and Psychotic Depression

To the Editor: I was intrigued by the findings of Meena Vythilingam, M.D., et al. (1) who reported that patients with psychotic major depression have a greater risk of death than patients with nonpsychotic major depression. This finding was based on a study that used survival analysis to assess the outcomes of 61 psychotic and 59 nonpsychotic depressed patients who were followed up for 15 years after hospital admission. The authors also reported that a positive dexamethasone suppression test (DST) result was associated with psychotic depression.

My colleagues and I reported relevant data some time ago that contrasts with these findings (2). We examined suicide rates in a group of 1,593 patients who had been hospitalized for unipolar and bipolar mood disorders. Subjects were followed up for 14 years. We concluded that psychotic and nonpsychotic subjects had similar risks for suicide and that among patients with a mood disorder, psychosis did not predispose to suicide. Dr. Vythilingam and co-workers did not specifically address the issue of suicide. We also reported that for a subset of 423 subjects given the DST, a positive result was significantly associated with the presence of delusions (3). A positive DST at baseline was not associated with subsequent suicide.

References

1. Vythilingam M, Chen J, Bremner JD, Mazure CM, Maciejewski PK, Nelson JC: Psychotic depression and mortality. Am J Psychiatry 2003; 160:574–576[Abstract/Free Full Text]
2. Black DW, Winokur G, Nasrallah A: Effect of psychosis on suicide risk in 1,593 patients with unipolar and bipolar affective disorders. Am J Psychiatry 1988; 145:849–852[Abstract/Free Full Text]
3. Black DW, Monahan PO, Winokur G: The relationship between DST results and suicidal behavior. Ann Clin Psychiatry 2002; 14:83–88[CrossRef][Medline]

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