Research Digest: Does Treating Depression Treat Suicidality?

This question has been deemed too complicated to answer, and I agree. But there is no doubt that clinically and publicly the answer to this question is significant.

The logic behind the question is that many, if not all, suicidal people are depressed. Theoretically, there are known treatments for depression, so can we generalise and say what works for depression will work for suicidality? However, we need more definitive evidence and a new study that will attempt to provide it.

The largest ever comparison of psychotherapy and pharmaceutical treatment for depression was conducted in the 1980’s. Patients were randomly allocated one of the following; cognitive therapy, interpersonal psychotherapy, antidepressant medication or a placebo. Plus there was a clinical control group.

This study was not targeting suicidality and in fact excluded some patients with moderate to severe suicidal thoughts. However, two of the primary measures of depression did each contain an item inquiring about suicidal thoughts. A further, different analysis, of these patients that did have some suicidal thoughts was done for the purpose of this research question.

Interpersonal psychotherapy and antidepressant medication seemed to reduce suicidality more than the pill placebo with clinical management. This wasn’t a conclusive find though and the placebo also seems to reduce suicidality in another comparison group. Further details of the analysis can be found here;

Essentially what the study revealed was a dilemma. Mild suicidal ideation appeared to be common amongst patients with depression seeking treatment but overall it does not predict suicide attempts. All the ways that researchers think of studying this become unstuck and are presented with some errors and huge difficulties with the sample.

All we are left with is the situation whereby we are attempting to address a clinical problem in studies with poor measures and inadequate samples – pretty much guaranteeing to never gain conclusive evidence. Perhaps we have to settle for this; depression treatment reduces depression, so it probably reduces suicidality.