Genetic Variations May Predispose Some Men To Suicidal Thoughts During Treatment For Depression

Genetic Variations May Predispose Some Men To Suicidal Thoughts During Treatment For Depression

Researchers at Harvard/Mass General have contributed some interesting data to the conversation about suicidality and antidepressant treatment. Roy Perlis and colleagues examined available DNA info on patients who had new onset suicidal thoughts after starting drug therapy, and found an interaction effect (sex x genetic variation) that suggested that the men with the genetic variation were at greater risk of suicidal thoughts. The article by Roy Perlis and colleagues appeared in the most recent issue of Archives of General Psychiatry. For a lay description of the study see this article in Medical News Today.

Because of the nature of the sample and the narrow scope of the findings, this study contributes most to the understanding about a possible link between suicidality and antidepressant use, about which I have posted before. But my main interest in it here relates to what new findings (especially those with a strong biomedical basis) mean to clinicians and how we think about risk assessment.

If replicated and expanded findings like these might lead to more targeted approaches to suicidality (and probably psychopharmacology for depression). However, for the clinician faced with an at-risk person in treatment, each new discovery will be merely one factor to synthesize into an overall, well-constructed risk formulation. It is doubtful we'll ever get to the point where a single data point (genetic or otherwise) will be strong enough to predict risk by itself. We'll always need good, old fashioned, clear-headed, complexity-embracing clinical judgment to discern risk. In fact, new findings related to risk (especially complex ones like those in the Perlis study) point out the importance of having a sturdy framework for thinking through risk assessment. A systematic framework allows the clinician to incorporate new findings into thinking and practice.

The need for a framework for thinking through risk may seem too obvious to mention. But consider what most training in suicide risk assessment consists of. Nearly every clinician I've spoken to (including myself) learned to assess suicide by asking a few basic questions about suicidal thinking, plan, intent, and ability to agree to stay safe. Most of us were not taught a "framework at all." We did not learn to assess for suicide risk the way we do other clinical issues--via systematic assessment and synthesis of multiple data points. In my opinion, that is why many clinicians I talk to feel so unsatisfied with the experience of working with people who voice suicidality.

All that to say...we're likely to see more genetic links with suicide risk. My goal is to be prepared to assimilate new findings within:

  • a compassionate and autonomy-respecting approach to gathering data (of all kinds) and intervening

  • a systematic way of thinking through multiple risk factors to arrive at a formulation

  • a coherent and predictable format for documenting and responding to risk