Adding cognitive therapy to antidepressant medications decreases suicidal ideation

Abstract

Background: Psychotherapy for depression and antidepressant medications have both been associated with decreases in suicidal ideation. Studies have not examined whether adding psychotherapy to antidepressant medications further reduces suicidal ideation relative to medications alone in adults.

Methods: Participants (N = 452) were randomized to 7 months of treatment with antidepressant medications or combined treatment with both medications and cognitive therapy for depression. We examined change in the suicide items from the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) across treatment using Bayesian generalized linear mixed models for non-continuous outcomes.

Results: Suicidal ideation decreased across treatment. When measured with the BDI, participants receiving both cognitive therapy and antidepressant medications showed 17% greater reductions in suicidal ideation relative to those receiving medications alone; this effect remained significant when controlling for depression severity. While the same pattern was observed when suicidal ideation was measured with the HDRS, the effect was smaller (7%) and not statistically significant. When BDI and HDRS scores were combined, participants receiving both therapy and medications showed 9% greater reductions in suicidal ideation relative to those receiving medications alone; this effect was marginally significant when controlling for depression severity.

Limitations: This is a secondary analysis of a randomized clinical trial designed to treat depression, in which suicidal ideation was assessed using single-item measures.

Conclusions: Adding cognitive therapy to antidepressant medications may reduce suicidal ideation to a greater extent than medications alone. Pending replication, combination treatment may be preferred for individuals with suicidal ideation.

Trial registration: clinicaltrials.gov Identifier: NCT00057577.

Keywords: Suicidal ideation; antidepressant medications; cognitive therapy; depression; treatment outcome.

Conflict of interest statement

Conflict of Interest

The authors report no conflicts of interest directly related to this work.

Published by Elsevier B.V.

Figures

Figure 1.

Baseline scores for the Beck Depression Inventory (BDI) suicide item and the Hamilton Depression Rating Scale (HDRS) suicide item.

Figure 2.

Percentages of Beck Depression Inventory suicide item scores at baseline and after 7 months of treatment

Figure 3.

Percentages of Hamilton Depression Rating Scale suicide item scores at baseline and after 7 months of treatment

Figure 4.

Percentages of the composite Beck Depression Inventory and Hamilton Depression Rating Scale suicide variable at baseline and after 7 months of treatment