AIMS: This study investigated clinical and genetic predictors of increasing suicidal ideation during antidepressant treatment. MATERIALS & METHODS: A total of 131 depressed outpatients were allocated to four antidepressants (paroxetine, venlafaxine, clomipramine or nefazodone) in a sequential step procedure until remission. Suicidality was assessed using the 10th item of the Montgomery-Asberg Depression Rating Scale (MADRS). A total of 11 candidate genes involved in different mechanisms of antidepressant action were selected for association with increasing suicidality. RESULTS: Increasing suicidality correlated with depression severity and higher antidepressant blood levels. Risk of increasing suicidal ideation was higher in subjects taking antidepressants other than paroxetine (odds ratio: 1.11). The strongest genetic predictor was found to be rs1360780 within the FKBP5 gene (p = 2.9 × 10(-5)), followed by 2677G>T in the ABCB1 gene. The rs130058 SNP within the 5-HTR1B gene demonstrated a differential association with increasing suicidal ideation depending on antidepressant type. CONCLUSION: Increasing suicidal ideation might be an adverse effect of antidepressants. The involvement of FKBP5 indicates that dysregulation of the hypothalamic-pituitary-adrenal axis is involved in treatment increasing suicidal ideation.
AIMS: This study investigated clinical and genetic predictors of increasing suicidal ideation during antidepressant treatment. MATERIALS & METHODS: A total of 131 depressed outpatients were allocated to four antidepressants (paroxetine, venlafaxine, clomipramine or nefazodone) in a sequential step procedure until remission. Suicidality was assessed using the 10th item of the Montgomery-Asberg Depression Rating Scale (MADRS). A total of 11 candidate genes involved in different mechanisms of antidepressant action were selected for association with increasing suicidality. RESULTS: Increasing suicidality correlated with depression severity and higher antidepressant blood levels. Risk of increasing suicidal ideation was higher in subjects taking antidepressants other than paroxetine (odds ratio: 1.11). The strongest genetic predictor was found to be rs1360780 within the FKBP5 gene (p = 2.9 × 10(-5)), followed by 2677G>T in the ABCB1 gene. The rs130058 SNP within the 5-HTR1B gene demonstrated a differential association with increasing suicidal ideation depending on antidepressant type. CONCLUSION: Increasing suicidal ideation might be an adverse effect of antidepressants. The involvement of FKBP5 indicates that dysregulation of the hypothalamic-pituitary-adrenal axis is involved in treatment increasing suicidal ideation.
Authors: John G Keilp; Michael F Grunebaum; Marianne Gorlyn; Simone LeBlanc; Ainsley K Burke; Hanga Galfalvy; Maria A Oquendo; J John Mann Journal: J Affect Disord Date: 2012-03-09 Impact factor: 4.839
Authors: Pilar Cristancho; Brendan O'Connor; Eric J Lenze; Daniel M Blumberger; Charles F Reynolds; David Dixon; Benoit H Mulsant Journal: Int J Geriatr Psychiatry Date: 2016-05-09 Impact factor: 3.485
Authors: Pamela Belmonte Mahon; Peter P Zandi; James B Potash; Gerald Nestadt; Gary S Wand Journal: Psychopharmacology (Berl) Date: 2012-12-30 Impact factor: 4.530