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Depression Treatment May Trigger Thoughts of Suicide in Genetically Predisposed Men

A study of 1,447 people with depression, conducted by Roy H. Perlis, M.D. of Massachusetts General Hospital and Harvard Medical School and his colleagues found that 10 percent of the men studied expressed suicidal thoughts during at least one follow up visit when none had been present prior to beginning treatment.

In an article released in the June issue of the Archives of General Psychiatry, Dr. Perlis and his associates pointed out that while most patients do well on antidepressants, a small subgroup experiences a worsening of symptoms up to and including thoughts of suicide. According to the authors, "Identification of this sub-population before treatment would have tremendous clinical utility."

Data for the study was gathered from participants of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study which was conducted from July 2001 to September 2006 that did not express suicidal thoughts at the beginning of the study. The DNA of the patients was analyzed for common types of mutations nearby or within the CREB1 gene. That specific gene codes for a protein previously suggested and strongly associated with the onset of suicidality in men, but not in women.

Additional studies of the same gene by the same group of researches prompted the following comment: "We recently observed an association between the same CREB1 polymorphisms and a measure of anger expression among males but not females in a sample of 94 patients with major depressive disorder; hostility and anger expressions have also been associated with suicide." The authors noted that studies that link genes to illnesses are most compelling when there is additional evidence of that gene's function.

"If replicated, this finding would suggest that pharmacogenetic testing could facilitate the identification of the small subset of individuals at greater risk during short-term antidepressant treatment."