The Corpus Callosum

The article describes a technique
that it said to show a priori which patients are at risk for
developing
suicidal thoughts after starting an antidepressant.  Of course the
usual
interpretive caveats apply: it is a small study, needs to be
replicated, etc.

href="http://www.technologyreview.com/biomedicine/25171/?a=f">Brain
Waves Predict Suicide Risk

A new technique might help doctors foresee suicidal thoughts
before a patient even has them.

Over the past five years, an increasing number of studies have pointed
to the rare but serious risk of suicidal thoughts that can accompany
new antidepressant treatments. Close monitoring is currently the only
clinical option, but a new technique–one that measures and analyzes
electrical activity of the brain–could one day predict which people
might be most susceptible to antidepressant-induced suicide.

While uncommon, the gravity of suicide risk was enough to prompt the
U.S. Food and Drug Administration to place a “black box” warning on
multiple antidepressant labels. So in order to tease out those
individuals at highest risk, researchers at the University of
California at Los Angeles’ Laboratory of Brain, Behavior, and
Pharmacology are using an approach called quantitative EEG (QEEG).


I’m not sure that this even will have much clinical utility,
although I remain open to the possibility.  From my point of view,
it will
take an awful lot of research to show that any technology is superior
to a) actually
talking to the patient, and b) listening carefully to the responses.

Focusing on the MRF region, Hunter then examined QEEGs from
72 adult patients who had been randomly assigned to take either
medication or placebo for eight weeks. At multiple time points–48
hours, one week, two weeks, four weeks, and eight weeks after starting
their therapy–the patients returned for QEEG measurements and a
mood-assessment questionnaire.

When Hunter examined the results, she found a striking effect: Those
patients on antidepressants who indicated any increase in suicidal
thoughts also showed a drastic decrease in activity in their MRF region
just 48 hours after starting their meds–six times the decrease shown
in subjects with no change in suicidal thoughts. But after one week,
the two groups were nearly identical again.

So what they saw, is a transient change in brain activity.  This
change occurred before any increase in suicidal thinking.  In
fact, the change went away before the suicidal thinking
increased.  Even so, the change was large in magnitude, and the
correlation was there. 

A different article on the same subject provide more detail, which
increases my skepticism:

href="http://www.sciencedaily.com/releases/2010/04/100409093411.htm">Simple
Test Can Detect Signs of Suicidal Thoughts in People Taking
Antidepressants

style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Arial,Helvetica,sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;"> class="Apple-style-span" style="text-align: left;">…Of the 37
participants on medication, five (13.5 percent) had worsening thoughts
of suicide.
..Of
note, eight of the 35 participants taking a placebo (22.9 percent) also
had increased thoughts of suicide. However, the placebo participants
did not show the precipitous drop in brain activity within the first 48
hours…



One thing that makes me skeptical about this: the FDA reviewed many
studies, involving many thousands of patients, before they were sure
that there is a correlation between antidepressant use and suicidal
thinking.  The relationship is difficult to find statistically,
even with large numbers of patients in multiple studies.  So how
likely is it that a study of 72 persons is going to tell us anything
conclusive?


Journal Reference:

A. M. Hunter, A. F. Leuchter, I. A. Cook, M. Abrams. Brain functional
changes (QEEG cordance) and worsening suicidal ideation and mood
symptoms during antidepressant treatment. Acta Psychiatrica
Scandinavica, 2010; DOI:

style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Arial,Helvetica,sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;"> class="Apple-style-span" style="text-align: left;"> href="http://dx.doi.org/10.1111/j.1600-0447.2010.01560.x"
rel="nofollow" target="_blank"
style="color: rgb(0, 0, 153); text-decoration: none;">10.1111/j.1600-0447.2010.01560.x

Comments

  1. #1 Neuroskeptic
    May 1, 2010

    Mmm…I wrote about my concerns with the qEEG / antidepressant approach previously…

  2. #2 drHoward
    June 13, 2010

    A severely depressed person is flat, numb, and has little insight. As the medication works then the person can actually talk about his or her feelings about depression and suicide. As a psychologist it is always a big break thru when a previously disengaged person can finally talk about their issues. The increased suicidal thoughts are a positive sign not a negative sign. But so many people are freaked out about suicidal statements they assume it is a bad thing. The quiet disengaged people kill themselves, if I can get them talking and keep them talking then life goes on.