A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age
Issued Date
2022-12-01
Resource Type
eISSN
1471244X
Scopus ID
2-s2.0-85134497366
Pubmed ID
35864465
Journal Title
BMC Psychiatry
Volume
22
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Psychiatry Vol.22 No.1 (2022)
Suggested Citation
Chee K.Y., Muhdi N., Ali N.H., Amir N., Bernardo C., Chan L.F., Ho R., Ittasakul P., Kwansanit P., Mariano M.P., Mok Y.M., Tran D.T., Trinh T.B.H. A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age. BMC Psychiatry Vol.22 No.1 (2022). doi:10.1186/s12888-022-04140-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85283
Title
A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age
Author's Affiliation
Ramathibodi Hospital
Makati Medical Center
University of the East Ramon Magsaysay Memorial Medical Center
Bach Mai Hospital
Universitas Airlangga
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
National University Hospital
Kuala Lumpur Hospital
Singapore Institute of Mental Health
Faculty of Medicine, UKM
Hospital Selayang
Somdejchaopraya Psychiatry Institute
Ho Chi Minh City Oncology Hospital
Makati Medical Center
University of the East Ramon Magsaysay Memorial Medical Center
Bach Mai Hospital
Universitas Airlangga
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
National University Hospital
Kuala Lumpur Hospital
Singapore Institute of Mental Health
Faculty of Medicine, UKM
Hospital Selayang
Somdejchaopraya Psychiatry Institute
Ho Chi Minh City Oncology Hospital
Other Contributor(s)
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.