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Review
. 2022 Jul 21;22(1):489.
doi: 10.1186/s12888-022-04140-6.

A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age

Kok Yoon Chee  1 , Nalini Muhdi  2 , Nor Hayati Ali  3 , Nurmiati Amir  4 , Carmina Bernardo  5 , Lai Fong Chan  6 , Roger Ho  7 , Pichai Ittasakul  8 , Patanon Kwansanit  9 , Melissa Paulita Mariano  10 , Yee Ming Mok  11 , Duy Tam Tran  12 , Thi Bich Huyen Trinh  13
Affiliations
Review

A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age

Kok Yoon Chee et al. BMC Psychiatry. .

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.

Keywords: Consensus; Depression; Southeast Asia; Suicide; Treatment.

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Conflict of interest statement

KYC, NM, NHA, NA, CB, LFC, RH, PI, PK, MPM, YMM, DTT and TBHT have served as consultants for Johnson & Johnson Pte Ltd. The authors have no other competing interests for this manuscript. In Vivo Communications [Asia] Pte. Ltd. which served as an independent third party in the editorial preparation of this manuscript, has no competing interests.

Figures

Fig. 1
Fig. 1
Consensus process. Abbreviations: MDSB, major depressive disorder with suicidal behavior
See this image and copyright information in PMC

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