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Genetic Markers of Suicidal Ideation Emerging During Citalopram Treatment of Major Depression

Objectives: Suicidal ideation is an uncommon symptom than can emerge during antidepressant treatment. The biological basis of treatment-emergent suicidal ideation is unknown. Genetic markers may shed light on the causes of treatment-emergent suicidal ideation and help identify individuals at high risk who may benefit from closer monitoring, alternative treatments, or specialty care. Method: A clinically representative cohort of outpatients with major depressive disorder who enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were treated with citalopram under a standard protocol for up to 14 weeks. DNA samples from 1,915 participants were genotyped for 768 single-nucleotide polymorphisms in 68 candidate genes. Allele and genotype frequencies were compared between the 120 participants who developed treatment-emergent suicidal ideation and those who did not. Results: Two markers were significantly associated with treatment-emergent suicidal ideation in this sample (marker rs4825476, p = 0.0000784, odds ratio = 1.94; permutation p = 0.01; marker rs2518224, p = 0.0000243, odds ratio = 8.23; permutation p = 0.003). These markers reside within the genes GRIA3 and GRIK2, respectively, both of which encode ionotropic glutamate receptors. Conclusions: Markers within GRIK2 and GRIA3 were associated with treatment-emergent suicidal ideation during citalopram therapy. If replicated, these findings may shed light on the biological basis of this potentially dangerous adverse event and help identify patients at increased risk.

(Reprinted with permission from the American Journal of Psychiatry 2007; 164:1530–1538)

Dr. Rush has served as an adviser, consultant, or speaker for or received research support from Advanced Neuromodulation Systems, Best Practice Project Management, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Forest Pharmaceuticals, Gerson Lehman Group, GlaxoSmithKline, Healthcare Technology Systems, Jazz Pharmaceuticals, Merck, NIMH, Neuronetics, Ono Pharmaceutical, Organon USA, Personality Disorder Research Corp., Pfizer, the Robert Wood Johnson Foundation, the Stanley Medical Research Institute, the Urban Institute, and Wyeth-Ayerst Laboratories. He has equity holdings in Pfizer and receives royalty/patent income from Guilford Publications and Healthcare Technology Systems. Dr. Charney has served as an adviser, consultant, or speaker for or received research support from Astra-Zeneca, Bristol-Myers Squibb, Cyberonics, Forest Laboratories, Gene-Logic, Institute of Medicine, Neuroscience Education Institute, Novartis, Organon International, and Quintiles, Inc. Drs. Laje, Paddock, Manji, Rush, Wilson, and McMahon are listed as co-inventors on a provisional patent application related to the findings in this article that was filed on October 27, 2006. All other authors report no competing interests.

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