Suicidal on Citalopram

The picture on the right is that of James Torlakson his daughter Elizabeth committed suicide while on Celexa.

I have been tracking this pharmacogenetic issuefor quite sometime now. Ironically, somepeople were at higher risk for suicide while on antidepressants. This had been known for some time with the drugs called SSRIs (selective serotonin reuptake inhibitors) These drugs act on a chemical in the brain which is thought when your levels are low can cause depression even suicide.

The mechanism is unclear as to how this happens. Until now we have not been able to accurately predict who may be at risk. That may soon change

Recently in the journal American Journal of Psychiatry a genetic analysis was performed on the largest study of antidepressant therapy. This study is called the STAR-D trial. There were prior genetic analyses done, but this appears the most promising.

In this analysis it appears that persons taking citalopram(Celexa) that have a change in their GRIK2 gene, called rs2518224 have 8 fold(800%) increased risk of treatment emergent suicidal risk. These are the kinds of Odds Ratios that make me perk up and say hello.

There is a pharmacogenetic test already in existence for this phenomenon. The test called Mark-C is being marketed by a company called NeuroMark and is an example of what more we shall see from labs in this space. I haven't got the specifics of this genetic test, but I have asked for more information on this. I will keep you in the loop.

The Sherpa Says: This is a very important study. However, I always caution that replication is the key to true genetic findings. But this looks pretty promising. I feel horrible for that family. Imagine how this could be prevented. However, similar data was posted on GRIK4 (not quite as good data thought)

Chronic Hepatitis C and Depression

The goal of personalized medicine is to

1. Apply prevention strategies to those uniquely at risk for disease
2. Give therapies that are uniquely suited for a molecular cause of disease
3. Avoid therapies that would not be useful and in fact may be harmful to those being treated

I am certain there are other goals, but I think these are the over-riding themes.

In a study in the journal Gastroenterology we see another example of how principle 3 comes into play.

This study examined patients with Hepatitis C. The therapy for Hepatitis C includes Interferon. This medication has long been known to cause depressive symptoms in a subset of patients who take this therapy. The study found that those patients who had a polymorphism in the HTR1A gene (aka serotonin receptor 1A) were almost 3 fold more likely to have interferon induced depression. Imagine combining this with the likelihood for cirrhosis polymorphism I mentioned in April. I can see it coming together, the right drug or not, for the right person, and the right disease.

The only catch is that these results need replication in a larger population.

Stay tuned