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Orsolini L, Latini R, Pompili M, Serafini G, Volpe U, Vellante F, Fornaro M, Valchera A, Tomasetti C, Fraticelli S, Alessandrini M, La Rovere R, Trotta S, Martinotti G, Di Giannantonio M, De Berardis D. Understanding the Complex of Suicide in Depression: from Research to Clinics. Psychiatry Investig 2020; 17:207-221. [PMID: 32209966 PMCID: PMC7113180 DOI: 10.30773/pi.2019.0171] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Amongst psychiatric disorders, major depressive disorder (MDD) is the most prevalent, by affecting approximately 15-17% of the population and showing a high suicide risk rate equivalent to around 15%. The present comprehensive overview aims at evaluating main research studies in the field of MDD at suicide risk, by proposing as well as a schematic suicide risk stratification and useful flow-chart for planning suicide preventive and therapeutic interventions for clinicians. METHODS A broad and comprehensive overview has been here conducted by using PubMed/Medline, combining the search strategy of free text terms and exploded MESH headings for the topics of 'Major Depressive Disorder' and 'Suicide' as following: ((suicide [Title/Abstract]) AND (major depressive disorder [Title/Abstract])). All articles published in English through May 31, 2019 were summarized in a comprehensive way. RESULTS Despite possible pathophysiological factors which may explain the complexity of suicide in MDD, scientific evidence supposed the synergic role of genetics, exogenous and endogenous stressors (i.e., interpersonal, professional, financial, as well as psychiatric disorders), epigenetic, the hypothalamic-pituitary-adrenal stress-response system, the involvement of the monoaminergic neurotransmitter systems, particularly the serotonergic ones, the lipid profile, neuro-immunological biomarkers, the Brain-derived neurotrophic factor and other neuromodulators. CONCLUSION The present overview reported that suicide is a highly complex and multifaceted phenomenon in which a large plethora of mechanisms could be variable implicated, particularly amongst MDD subjects. Beyond these consideration, modern psychiatry needs a better interpretation of suicide risk with a more careful assessment of suicide risk stratification and planning of clinical and treatment interventions.
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Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy.,Polyedra, Teramo, Italy
| | - Roberto Latini
- Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Umberto Volpe
- Department of Clinical Neurosciences/DIMSC, School of Medicine, Section of Psychiatry, Polytechnic University of Marche, Ancona, Italy
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy
| | - Michele Fornaro
- Polyedra, Teramo, Italy.,Department of Psychiatry, Federico II University, Naples, Italy
| | - Alessandro Valchera
- Polyedra, Teramo, Italy.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Carmine Tomasetti
- Department of Mental Health, National Health Service, Psychiatric Service of Diagnosis and Treatment, Hospital "SS. Annunziata" ASL 4, Giulianova, Italy
| | - Silvia Fraticelli
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy
| | - Marco Alessandrini
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy
| | - Raffaella La Rovere
- Department of Mental Health, National Health Service, Azienda Sanitaria Locale, Pescara, Italy
| | - Sabatino Trotta
- Department of Mental Health, National Health Service, Azienda Sanitaria Locale, Pescara, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy
| | - Domenico De Berardis
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University of "G. D'Annunzio", Chieti, Italy.,Department of Mental Health, National Health Service, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy
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Bartova L, Dold M, Kautzky A, Fabbri C, Spies M, Serretti A, Souery D, Mendlewicz J, Zohar J, Montgomery S, Schosser A, Kasper S. Results of the European Group for the Study of Resistant Depression (GSRD) - basis for further research and clinical practice. World J Biol Psychiatry 2019; 20:427-448. [PMID: 31340696 DOI: 10.1080/15622975.2019.1635270] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The overview outlines two decades of research from the European Group for the Study of Resistant Depression (GSRD) that fundamentally impacted evidence-based algorithms for diagnostics and psychopharmacotherapy of treatment-resistant depression (TRD). Methods: The GSRD staging model characterising response, non-response and resistance to antidepressant (AD) treatment was applied to 2762 patients in eight European countries. Results: In case of non-response, dose escalation and switching between different AD classes did not show superiority over continuation of original AD treatment. Predictors for TRD were symptom severity, duration of the current major depressive episode (MDE), suicidality, psychotic and melancholic features, comorbid anxiety and personality disorders, add-on treatment, non-response to the first AD, adverse effects, high occupational level, recurrent disease course, previous hospitalisations, positive family history of MDD, early age of onset and novel associations of single nucleoid polymorphisms (SNPs) within the PPP3CC, ST8SIA2, CHL1, GAP43 and ITGB3 genes and gene pathways associated with neuroplasticity, intracellular signalling and chromatin silencing. A prediction model reaching accuracy of above 0.7 highlighted symptom severity, suicidality, comorbid anxiety and lifetime MDEs as the most informative predictors for TRD. Applying machine-learning algorithms, a signature of three SNPs of the BDNF, PPP3CC and HTR2A genes and lacking melancholia predicted treatment response. Conclusions: The GSRD findings offer a unique and balanced perspective on TRD representing foundation for further research elaborating on specific clinical and genetic hypotheses and treatment strategies within appropriate study-designs, especially interaction-based models and randomized controlled trials.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , United Kingdom
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy
| | | | | | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | | | - Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria.,Zentrum für seelische Gesundheit Leopoldau, BBRZ-MED , Vienna , Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
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Schosser A, Carlberg L, Calati R, Serretti A, Massat I, Spindelegger C, Linotte S, Mendlewicz J, Souery D, Zohar J, Montgomery S, Kasper S. The Impact of BDNF Polymorphisms on Suicidality in Treatment-Resistant Major Depressive Disorder: A European Multicenter Study. Int J Neuropsychopharmacol 2017; 20:782-787. [PMID: 28977521 PMCID: PMC5632306 DOI: 10.1093/ijnp/pyx028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Numerous studies have reported associations between the brain-derived neurotrophic factor (BDNF) gene and psychiatric disorders, including suicidal behavior, although with conflicting results. METHODS A total of 250 major depressive disorder patients were collected in the context of a European multicenter resistant depression study and treated with antidepressants at adequate doses for at least 4 weeks. Suicidality was assessed using the Mini International Neuropsychiatric Interview and Hamilton Rating Scale for Depression, and treatment response using the HAM-D. Genotyping was performed for the functional Val66Met polymorphism (rs6265) and 7 additional tagging single nucleotide polymorphisms within the BDNF gene. RESULTS Neither BDNF single markers nor haplotypes were found to be associated with suicide risk and lifetime history of suicide attempts. Gender-specific analyses revealed nonsignificant single marker (rs908867) and haplotypic association with suicide risk in males after multiple testing correction. Analyzing treatment response phenotypes, the functional Val66Met polymorphism as well as rs10501087 showed significant genotypic and haplotypic association with suicide risk in remitters (n=34, 13.6%). CONCLUSIONS Considering the sample size, the present findings need to be replicated in larger samples to confirm or refute a role of BDNF in the investigated suicidal behavior phenotypes.
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Affiliation(s)
- Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Laura Carlberg
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Raffaella Calati
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Alessandro Serretti
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Isabel Massat
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Christoph Spindelegger
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Sylvie Linotte
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Julien Mendlewicz
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Daniel Souery
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Joseph Zohar
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Stuart Montgomery
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery)
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria (Drs Schosser, Carlberg, Spindelegger, and Siegfried); Zentrum für Seelische Gesundheit, Leopoldau, Austria (Dr Schosser); INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France (Dr Calati); Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Dr Serretti); Laboratory of Experimental Neurology, National Fund of Scientific Research, Brussels, Belgium (Dr Massat); Université Libre de Bruxelles, Brussels, Belgium (Ms Linotte and Dr Mendlewicz); Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europe en de Psychologie Medicale, Brussels, Belgium (Dr Souery); Chaim Sheba Medical Center, Tel-Hashomer, Israel (Dr Zohar); Imperial College, School of Medicine, University of London, United Kingdom (Dr Montgomery).,Correspondence: Siegfried Kasper, MD, Professor and Chair, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria ()
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