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September 10th is Suicide Prevention Day. Approximately 10 Canadians die by suicide every day. Suicide is currently ranked as the 9th leading cause of death. According to the Canadian Community Health Survey, 14.7% of the population has thought about suicide and 3.5% have attempted suicide in their lifetime.
Here are some resources on suicide and depressive disorders selected by Joule’s Ask a Librarian team using a variety of tools included with CMA membership.
Clinical summary from DynaMed
Access DynaMed online or through the mobile app to get concise overviews and detailed recommendations, medical graphics and images, drug information from Micromedex and more.
Major Depressive Disorder
- Hospitalization or immediate specialist consultation is usually needed for patients who pose a serious threat of harm to self or others (Strong recommendation) and should be considered for those that are severely depressed, especially if they lack social supports or have a complicating medical or psychiatric conditions.
Recommended initial treatment choices:
- For mild-to-moderate depression in adults:
- psychotherapy is recommended as an initial treatment option in most cases (Strong recommendation)
- consider antidepressants as an alternative initial therapy in some cases (Weak recommendation)
- a prior history of moderate or severe depression
- subthreshold symptoms lasting ≥ 2 years
- consider a combination of psychotherapy plus an antidepressant if there are comorbid psychosocial problems (Weak recommendation)
- For moderate-to-severe depression use a combination of an antidepressant plus psychotherapy (Strong recommendation):
- Consider electroconvulsive therapy (ECT) for severe depression if the patient is unresponsive to psychotherapy plus antidepressants or if there is an urgent need for rapid response (suicidal, food refusal, catatonic) (Weak recommendation).
- For most patients, optimal medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), mirtazapine, or bupropion (Strong recommendation).
- if patient is pregnant or lactating, individualize medical treatment if psychotherapy has failed as sole treatment.
- Among important adverse events of antidepressant therapy, there is an increased risk of suicidality, generally in the first 1-2 months of treatment, in young adults aged 18-24 years.
Clinical summary from Essential Evidence Plus
Essential Evidence Plus is an evidence-based point of care tool with access to over 13,000 topics, guidelines, abstracts and summaries. For a synopsis of new evidence reviewed by the Essential Evidence Plus editorial team, subscribe to the POEMs daily newsletter.
Suicide risk assessment and management
- Treat underlying contributors with cognitively oriented psychotherapy (e.g. problem solving therapy, CBT, dialectical behavior therapy) and psychotropic medication. (B level evidence)
- Provide a way to contact provider and local or national hot-lines for suicide. (C level evidence)
- Hospitalize if attempt is imminent or risk of suicide is deemed high. (G2 level evidence)
- If patient is a danger to self, involuntary hospitalization can be imposed by the physician (laws vary by state). (C level evidence).
Read more via Essential Evidence Plus (CMA members only)
Synopsis of clinical studies in POEMs by Essential Evidence Plus:
POEM: CBT effective in adolescents with depression who don't want medication
In adolescents who eschew drug treatment of major depression, short-term cognitive behavioral therapy (CBT) is more effective than treatment as usual in inducing recovery, with a number needed to treat of 4 to 10. CBT also produced faster results. (LOE = 1b)
Reference: Clarke G, DeBar LL, Pearson JA, et al. Cognitive behavioral therapy in primary care for youth declining antidepressants: A randomized trial. Pediatrics 2016;137(5):e20151851.
Book chapters via ClinicalKey (CMA members only):
ClinicalKey drives better care by delivering fast, concise answers, and deep access to evidence whenever, wherever you need it. ClinicalKey includes access to 1,000+ textbooks, 600 full-text journals, images, videos and customizable patient handouts across 30+ medical specialties
- Suicide, by Marian E. Betz and Jeffrey M. Caterino, in Rosen's Emergency Medicine: Concepts and Clinical Practice, Chapter 105, 1366-1373.e3
- Depressive Disorders and Bipolar, by Karen J. Marcdante MD and Robert M. Kliegman MD, in Nelson Essentials of Pediatrics, Chapter 18, 64-68
- Care of the Suicidal Patient, by Rebecca Weintraub Brendel M.D., J.D., Katherine A. Koh M.D., M.Sc., Roy H. Perlis M.D., M.Sc. and Theodore A. Stern M.D., in Massachusetts General Hospital Handbook of General Hospital Psychiatry, 44, 491-500.e5
Articles via CMAJ:
Joy Albuquerque and Sarah Tulk, CMAJ
May 06, 2019 191 (18) E505; DOI: https://doi.org/10.1503/cmaj.181687
Myles Gaulin, Marc Simard, Bernard Candas, Alain Lesage and Caroline Sirois, CMAJ
July 02, 2019 191 (26) E724-E732; DOI: https://doi.org/10.1503/cmaj.181712
Mark Sinyor, Benjamin I. Goldstein and Ayal Schaffer, CMAJ
July 02, 2019 191 (26) E722-E723; DOI: https://doi.org/10.1503/cmaj.190709
Clinical Practice Guidelines via CPG Infobase:
CPG Infobase contains approximately 1,200 evidence-based Canadian clinical practice guidelines (CPGs) developed or endorsed by authoritative medical or health organizations in Canada.
Canadian Clinical practice guidelines on depression in CPG Infobase.
Drug Information via CPS online and on the RxTx app (CMA members only):
CPS offers 2000+Canadian product monographs for drugs, vaccines and natural health products that are developed by manufacturers, approved by Health Canada and optimized by CPhA editors
Search “depression” in the CPS on the RxTx app to find related monographs and the Drug Choices table which provides dosage, adverse effects, drug interactions and relative cost of treatment for medications.
Need more information or have a more focused clinical question on depressive disorders or suicide (or any other clinical topic of interest)? Contact the Ask a Librarian team to request a literature search.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule. Feel passionate about physician-led innovation? Please connect with us at firstname.lastname@example.org.