Project Summary

Michael F. Grunebaum, M.D. (Young Investigator 2004) of New York State Psychiatric Institute/Columbia University, proposes comparing two antidepressants--a selective serotonin reuptake inhibitor (SSRI) and bupropion, a non-serotonergic drug--for their effects in reducing impulsivity and suicidal ideation in people with major depression. Some evidence suggests SSRIs may reduce impulsive aggression and, therefore, lower suicidal behavior risk. Dr. Grunebaum will now test those findings by comparing an SSRI with bupropion in a randomized, controlled trial of patients with major depressive disorder who have a prior history of suicide attempt and, therefore, a vulnerability for impulsivity and suicidal ideation. Unlike most antidepressant clinical trials, this one will not exclude suicidal patients. Participants will get six months of antidepressant pharmacotherapy and patients will then be referred for ongoing treatment. Patients will be referred for psychotherapy where indicated. Suicidal ideation is relatively frequent in depression, and together with impulsivity, is an important risk factor for suicide attempts. The two drugs will be assessed by whether they 1) reduce neuropsychological measures of impulsivity; 2) reduce suicidal ideation; and 3) affect the occurrence of suicidal ideation or acts necessitating a change in treatment.

Program Area: MOOD DISORDERS\Unipolar Depression\Suicide

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