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Are Patients With Depression at Heightened Risk of Suicide as They Begin to Recover?

Dr. Mittal is affiliated with the Department of Psychiatry, Yale University, New Haven, Connecticut. Dr. Brown, to whom correspondence may be sent, is with Warren Alpert Medical School, Brown University, 108 Driftwood Dr., Tiverton, RI 02878 (e-mail: walter_brown{at}brown.edu). Dr. Shorter is with the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

It has long been taught and believed that patients with depression and suicidal tendencies are at heightened risk of suicide as they begin to recover and their energy and motivation return. What are the data behind this enduring belief? More than a century ago, eminent clinicians noted that some patients with depression committed suicide just as their depression seemed to be improving. The clinicians went on to warn that early recovery carries a high risk of suicide. Although no studies have tracked suicide along with symptomatic change in depression, recent large-scale studies of suicide and phase of treatment do not indicate that suicide is more likely to occur early in recovery than at other times. Our forebears helpfully pointed out that patients with depression may commit suicide as they are beginning to recover. But the idea that these patients are at particular risk of suicide at this time, intuitively plausible as it is, remains to be substantiated.

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