A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age
Abstract Background The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of cl...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04140-6 |
| _version_ | 1817969693139402752 |
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| author | Kok Yoon Chee Nalini Muhdi Nor Hayati Ali Nurmiati Amir Carmina Bernardo Lai Fong Chan Roger Ho Pichai Ittasakul Patanon Kwansanit Melissa Paulita Mariano Yee Ming Mok Duy Tam Tran Thi Bich Huyen Trinh |
| author_facet | Kok Yoon Chee Nalini Muhdi Nor Hayati Ali Nurmiati Amir Carmina Bernardo Lai Fong Chan Roger Ho Pichai Ittasakul Patanon Kwansanit Melissa Paulita Mariano Yee Ming Mok Duy Tam Tran Thi Bich Huyen Trinh |
| author_sort | Kok Yoon Chee |
| collection | DOAJ |
| description | Abstract Background The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. Methods A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. Results Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification – incorporating both severity and temporality, or using a prevention-focused risk formulation – should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. Conclusions There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option. |
| first_indexed | 2024-04-13T20:24:24Z |
| format | Article |
| id | doaj.art-144c37bf95c3462c883efdbb030500e0 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-13T20:24:24Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-144c37bf95c3462c883efdbb030500e02022-12-22T02:31:25ZengBMCBMC Psychiatry1471-244X2022-07-0122111310.1186/s12888-022-04140-6A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of ageKok Yoon Chee0Nalini Muhdi1Nor Hayati Ali2Nurmiati Amir3Carmina Bernardo4Lai Fong Chan5Roger Ho6Pichai Ittasakul7Patanon Kwansanit8Melissa Paulita Mariano9Yee Ming Mok10Duy Tam Tran11Thi Bich Huyen Trinh12NEURON, Department of Psychiatry & Mental Health, Kuala Lumpur HospitalDepartment of Psychiatry, Dr Soetomo General Hospital; Faculty of Medicine, Universitas AirlanggaDepartment of Psychiatry & Mental Health, Selayang HospitalDepartment of Psychiatry, Ciptomangunkusumo Hospital; Faculty of Medicine, Universitas IndonesiaMood and Anxiety Resource and Referral Center, Professional Services, Department of Neuroscience, Makati Medical CenterDepartment of Psychiatry, Faculty of Medicine, University Kebangsaan MalaysiaDepartment of Psychological Medicine, National University HospitalDepartment of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversitySomdejchaopraya Psychiatry InstituteDepartment of Psychiatry, University of the East Ramon Magsaysay Memorial Medical CenterInstitute of Mental HealthHo Chi Minh Psychiatric HospitalBach Mai HospitalAbstract Background The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. Methods A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. Results Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification – incorporating both severity and temporality, or using a prevention-focused risk formulation – should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. Conclusions There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.https://doi.org/10.1186/s12888-022-04140-6DepressionSuicideTreatmentSoutheast AsiaConsensus |
| spellingShingle | Kok Yoon Chee Nalini Muhdi Nor Hayati Ali Nurmiati Amir Carmina Bernardo Lai Fong Chan Roger Ho Pichai Ittasakul Patanon Kwansanit Melissa Paulita Mariano Yee Ming Mok Duy Tam Tran Thi Bich Huyen Trinh A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age BMC Psychiatry Depression Suicide Treatment Southeast Asia Consensus |
| title | A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| title_full | A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| title_fullStr | A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| title_full_unstemmed | A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| title_short | A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| title_sort | southeast asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age |
| topic | Depression Suicide Treatment Southeast Asia Consensus |
| url | https://doi.org/10.1186/s12888-022-04140-6 |
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