Major depressive disorder: who are prone to relapses? Is alcohol abuse a risk factor for suicide?

In this article, we review the data from the latest research on the recurring major depressive disorder and the risk of suicide in individuals with mental disorders and alcohol addiction.

According to statistics, major depression recurs in 60% of cases. This question was studied by Malaysian psychiatrists who tried to distinguish relapse factors by analyzing data on patients with non-psychotic major depression.

The analysis included 201 patients with non-psychotic depression without any other mental disorders, i.e. anxiety, OCD, and others.

The researchers assessed the demographic and clinical features of patients, in particular, the severity of the initial episode of depression, other chronic diseases, and family history of psychiatric illness. In addition, 8 single nucleotide polymorphisms were identified, which belonged to the genes of the vitamin D receptor, the type 3 zinc transporter, the type 1 dopamine transporter, the brain neurotrophic factor, and the 5-HT 1A and 2A serotonin receptors.

Data on 145 patients were collected and analyzed 5 after the study start:

- 21% of patients had a relapse of major depression;
- The risk of relapse was substantially higher among patients with an initially severe episode of depression (hazard ratio, 5.6) and among patients with higher rates of social avoidance (hazard ratio, 3.5).
- It had been concluded that the severity of the initial depressive episode is connected to the single nucleotide polymorphism of the vitamin D receptor gene. AA genotype is considered to be related to the 6.4 fold rise of recurrence in severe depression compared to mild and moderate forms, and C/A genotype increased the risk by 11.3 fold. Note that polymorphism in the vitamin D receptor gene may be involved in serotonin imbalance.
- This study has shown for the first time that social avoidance is a potential risk factor for the recurrence of major depressive disorder.

Suicide risk in patients with alcoholism and psychiatric diseases

Research results demonstrate a high risk of suicide in patients with alcohol dependence. However, it is not completely clear what additional contribution is made by comorbid psychiatric diseases and genetic factors.
The longitudinal population study included indigenous people of Sweden born from 1950 to 1970 (2,229,880) who were followed until 2012.
The researchers were interested in the risk of suicide depending on the presence or absence of alcoholic dependence. In those included in the analysis, mental disorders, in particular, major depressive disorder, were taken into account.

Results of the study show that:

- The frequency of suicide during the study period was 3.54% among women and 3.94% among men with the alcoholic illness, compared to 0.29% for women and 0.76% for men without alcohol dependence;
- The risk was highest in the first 5 years after diagnosis (adjusted hazard ratio, women, 128; men, 28) and declined in subsequent years to 2.61 for women and 2.44 for men;
-  The risk of suicide was highest in patients diagnosed at a young age. Psychiatric comorbid pathologies were common in patients with the alcoholic illness. It was noted that among patients with mental disorders (28% of patients with alcoholism), the risk of suicide was 74 times higher in women and 21 times in men than among patients without alcohol dependence.

Conclusion

Alcohol illness is a potential risk factor for suicide. This risk does not depend on psychiatric comorbid pathologies and is especially high in women, in patients with an early diagnosis, and within the first five years after diagnosis.

It is important not to overlook mental disorders and alcohol abuse and receive appropriate treatment with the recommended drugs, first of all, new generation antidepressants such as Paroxetine. Only a timely visit to a specialist, comprehensive approach and following of the prescribed treatment can prevent serious complications and substantially reduce the risk of suicide. Do not hesitate to seek professional help for yourself or your loved ones who are showing the signs of a mental disease or suffer from alcohol abuse.

Post by: John De Vries, clinical pshychiatrist, Amsterdam, Netherlands