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Table 4 Characteristics of suicidality events

From: Suicidality and divalproex sodium: analysis of controlled studies in multiple indications

Study Treatment Event, study day(s) Age, years Gender Adverse event term(s) Relevant history
Completed suicide: 0
Suicide attempts: 4
Mania maintenance DVPX 241 21 Female Overdose, suicide attempt Benzodiazepine overdose after a family conflict. Family history of bipolar disorder; history of previous SA.
Mania maintenance DVPX 313 43 Female Manic depressive reaction, overdose, suicide attempt Benzodiazepine overdose. Family history of alcoholism, ADHD; previous SA approximately 12 months prior; SADS-C suicidal tendency score was 1 (not at all) on day 308.
Mania maintenance Placebo 71 29 Female Overdose Benzodiazepine + alcohol combination 'due to poor judgment'. Marital break-up and lost custody of children. Family history of anxiety, depression.
Bipolar depressiona Placebo 19 18 Male Euphoria, abdominal pain, overdose Amphetamine overdose. One SA in past year; mother died in past year; HAM-D rated as 0 (absent) and BPRS rated as 0 (not present) on day 15.
Preparatory acts toward imminent suicidal behavior: 1
Mania maintenance Placebo 29 26 Female Depression Severe depression and suicidal ideation 1 day post treatment. Family history of mood, eating, and drug abuse disorders; history of borderline personality disorder; five SA since 1983 (last approximately 1 year prior); SADS-C rated as 1 (not at all) on day -1, 2 (slight) on day 7 and 5 (severe) on day 29.
Suicidal ideation: 15b
Epilepsy, adjunctive CPS DVPX 19 21 Female Depression Severe thoughts of suicide that resolved the next day. History of drug abuse (approximately 1 year recovered), violent during seizures, and decreased mental sharpness; CBZ.
Acute mania DVPX 2 33 Female Depression Moderate suicidal thoughts lasting 6 hours after a 'family event'. SADS-C rated as 0 (not at all) on day -1 and day 5.
Mania maintenance DVPX 24 52 Male Depression Moderate suicidal ideation. Family history of suicide, abuse, electroconvulsive therapy, and residing in mental institution; history of obesity, diabetes, cardiovascular disease; SADS-C rated as 2 (slight) on day 15 and 4 (moderate) on day 30.
Mania maintenance DVPX 23 31 Female Depression Severe depression, BDI indicated suicidal ideation. Family history of mood swings; SADS-C rated as 1 (not at all) on days -1 and 7, and 5 (severe) on day 24.
Mania maintenance DVPX 196 22 Male Depression Severe depression and suicidal ideation. SADS-C rated as 3 (mild) on day 1.
Mania maintenance DVPX 1 28 Male Thinking abnormal thoughts Moderate fleeting thoughts of wanting to hurt self (non-suicidal). SADS-C rated as 1 (not at all) on day -1, and 2 (slight) on day 18.
Mania maintenance DVPX 44, 234 45 Male Depression Two episodes of suicidal ideation (severe and mild, respectively). Family history of depression; SADS-C rated as 6 (extreme) on day 55 and 3 on day 218; paroxetine.
Impulsive aggression DVPX 16 37 Male Depression Severe hostility, depression and suicidal ideation, 'stress due to friend's death'. History of major depression, HIV positive (3 months), childhood physical abuse, possible PTSD; HAM-D rated as 1 (life not worth living) on day -22.
Impulsive aggression DVPX 38 36 Female Depression Moderate feelings of worthlessness and hopelessness, mild thoughts of suicide. History of intermittent explosive disorder, alcohol dependence, cluster B personality disorder-borderline; HAM-D was rated as 0 (absent) on days 28 and 48.
Mania maintenance Placebo 54 31 Male Depression Severe suicidal ideation and intent. Family history of depression; history of panic attacks; SADS-C rated as 3 (mild) on day 43 and 6 (extreme) on day 54; thyrosin, sertraline.
Mania maintenance Placebo 188 45 Female Manic depressive reaction Severe suicidal ideation. Family history of bipolar disorder, depression; SADS-C rated as 1 (not at all) on day 175 and 5 (severe) on day 188.
Mania maintenance Placebo 116 41 Female Manic depressive reaction Severe suicidal ideation and psychosis; SADS-C rated as 1 (not at all) on day 111 and 4 (moderate) on day 116.
Mania maintenance Placebo 131 38 Male Depression Mild and transient suicidal ideation after ethanol consumption. Family history of bipolar disorder; SADS-C rated as 2 (slight) on day 115.
Mania maintenance Placebo 39 32 Female Psychotic depression Severe depression and suicidal ideation. Family history of depression; SADS-C rated as 3 (mild) on day 28.
Impulsive aggression Placebo 20 31 Female Depression Mild suicidal ideation with no plans/means that resolved within 2 hours. History of major depression, physical abuse, witnessed domestic violence, borderline cluster B personality disorder; HAM-D rated as 0 (absent) on day -15 and 28.
Epilepsy, monotherapy Low-dose DVPX 17 33 Female Depression Moderate depression and thoughts of suicide. Marital and financial issues; history of anxiety, CBZ.
  1. aThis subject also experienced an event of suicidal ideation (code 4) on day 17; only the most severe event is included in this table.
  2. bN = 15 in placebo-controlled studies when counting the most severe event in patients experiencing >1 event.
  3. ADHD = attention-deficit hyperactivity disorder; BDI = Beck Depression Inventory; BPRS = Brief Psychiatric Rating Scale suicidal thoughts; CBZ = carbamazepine; CPS = complex partial seizures; DVPX = divalproex sodium; HAM-D = Hamilton Depression Rating Scale suicide score; PTSD = post-traumatic-stress disorder; SA = suicide attempt; SADS-C = Schedule for Affective Disorders and Schizophrenia-Change Version suicidal tendency score.