Suicide characteristics in patients with marked treatment-resistant major depressive disorder: A RECOVER trial report

Background: Suicide attempts are a major concern in major depressive disorder (MDD), especially for those with multiple prior unsuccessful treatment trials. This report compares baseline demographic, clinical features, and treatment history of participants with marked treatment-resistant, nonpsychotic MDD based on lifetime history of suicide attempt (SA vs NSA). Methods: RECOVER is a randomized, sham-controlled trial of vagus nerve stimulation and the largest such trial of a psychiatric neuromodulation intervention. Baseline data were analyzed. Univariate analyses (SA vs NSA) and logistic regression with backward selection (variables with univariate p <0.1) were performed. Results: SA group (N = 196) was more likely than NSA group (N = 297) to be female (72.4% vs 61.6%), <65 years of age (73.5% vs 61.6%), have earlier onset of depressive symptoms (mean, 19.1 vs 22.5 years), earlier diagnosis of MDD (mean, 25.0 vs 29.2 years), higher percentage of lifetime in depressive episodes (mean, 56.0% vs 51.0%), more failed antidepressants (mean, 15.0 vs 12.1), and greater lifetime use of electroconvulsive therapy (ECT; 55.1% vs 40.1%). Female sex, age at MDD diagnosis, number of failed antidepressants, number of psychiatric hospitalizations, and baseline suicide score retained association with logistic regression analysis. Limitations: Information on medical morbidity of suicide attempts was not collected and timing of suicide attempts relative to treatment exposures was unknown. Conclusions: For marked treatment-resistant MDD, those with prior suicide attempts have more complex course of illness with earlier onset of depressive symptoms, earlier diagnosis of MDD, more lifetime spent in depressive illness, more failed antidepressant medication trials, and greater use of ECT. Trial registration: ClinicalTrials.gov Identifier NCT03887715.