Sleep and circadian rhythm alterations and suicidal ideation in depressed patients: results from a prospective cohort study.
Pr Llorca is Professor of Psychiatry at the University Clermont Auvergne (UCA) in Clermont-Ferrand, France. He is at the head of the Psychiatric Department in the University Medical Center in Clermont-Ferrand. He is the Past President of the Ethics Committee of Auvergne. He is member of the French Society for Biological Psychiatry and Neuropsychopharmacology, of the European Psychiatric Association and of the World Federation for Biological Psychiatry. He is a member of the executive committee of the French Foundation for Mental Health “FondaMental”, and the national coordinator of the 4 French Networks of the “FondaMental” Expert Centers (Schizophrenia, Bipolar, Asperger and Treatment Resistant Depression).
His research interests include pharmacodynamic and pharmacokinetic approaches of psychotropics - and more specifically antipsychotics and antidepressants -, determinants of adherence to treatment (e.g., attitudes and beliefs related to treatment).
He is the Principal Investigator of the PsyCoh Schizophrenia Project (French cohort of schizophrenia patients), and leader of the Work Package 1 (French Minds Cohort) of the ProPSY project,both funded by the PIA (Programme Investissement d’Avenir). He is co-director of the theme “Image and Connectomics in Clinical Neurosciences” (ICCN) in Research Unit UMR CNRS UCA 6602 - Institut Pascal.
He is the coordinator of the Research Axis for Neuroscience of Clermont University Hospital. He coordinates with Prof Jardri (Lille) F-PsyNET, a national research network for Psychotic Disorders labelled by INSERM in 2022.
He published more than 440 articles in peer-review journals.
Sleep and circadian rhythm alterations are core symptoms of major depressive disorder and are frequently associated with suicidal ideation.
We conducted a study in a prospective cohort of treatment-resistant depressed patients to explore sleep and circadian rhythm alterations and correlation with suicidal ideation. Mood, sleep, circadian rhythms, and suicidal risk were assessed at baseline and during a one-year follow-up in a cohort of 261 depressed patients, from the French network of Treatment-Resistant Depression Expert Centers.We used standardized questionnaires including the Montgomery Asberg Depression Rating Scale (MADRS), the 19-item Pitsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Composite Scale of Morningness (CSM), the measure of suicidal ideation (ISF), and The Columbia suicide Severity Rating Scale (CSSRS).
Excessive daytime sleepiness (adjusted odds ratio aOR = 1.7(1–3.3), p = 0.04) and daytime dysfunction (aOR = 1.81(1.16–2.81), p = 0.0085) are associated with an increased risk of suicidal thoughts over the one-year follow-up period in our sample after adjustment on age, gender, depression, trauma, anxiety, impulsivity, current daily tobacco smoking and body mass index. Hypnotics intake is associated with a reduced risk of suicidal ideation at one-year follow-up after the same adjustments (OR = 0.73(0.56–0.95), p = 0.019). Other associations between sleep quality or circadian rhythms and suicidal ideations at either baseline or one year did not remain significant in multivariate analyses after the same adjustments. One limitation of our study is that sleep assessments were based on self-reported questionnaires rather than objective measures. Daytime sleepiness and dysfunction are predictors of suicidal ideations, whereas hypnotics intake is associated with a reduced risk of suicidal ideations.
Diurnal symptoms of sleep disturbances must be systematically evaluated for preventing suicide in depressed patients.
Role of hypnotics must be considered according to the reduction of suicidal ideation observed in our cohort associated with their prescription.
Reference:
Maruani J, Moli.re F, Godin O, Yrondi A, Bennabi D, Richieri R, El-Hage W, Allauze E, Anguill L, Bouvard A, Camus V, Dorey JM, Etain B, Fond G, Genty JB, Haffen E, Holtzmann J, Horn M, Kazour F, Nguon AS, Petrucci J, Rey R, Stephan F, Vaiva G, Walter M; FondaMental Advanced Centers of Expertise in Resistant Depression (FACE-DR) Collaborators; Lejoyeux M, Leboyer M, Llorca PM, Courtet P, Aouizerate B, Geoffroy PA.
Diurnal symptoms of sleepiness and dysfunction predict future suicidal ideation in a French cohort of outpatients (FACE-DR) with treatment resistant depression: A 1-year prospective study about sleep markers. J Affect Disord. 2023 May 15; 329: 369-378.