Psychiatric Disorders Increase Risk of Suicidal Behavior in Patients in HD Trials

Active psychiatric disorders are associated with an increased risk of suicidal behaviors in Huntington’s patients participating in clinical trials, a large study suggests.

The study, “Risk factors for suicidality in Huntington’s disease: an analysis of the 2CARE clinical trialwas published in Neurology.

Huntington’s disease is primarily recognized for its motor symptoms, including impaired gait and muscle rigidity, but patients may also present with behavioral, cognitive and psychiatric disorders.

Suicidal behaviors, in particular, may affect up to 20% of symptomatic and pre-symptomatic patients. Suicide is 12 times more common in Huntington’s patients than in the general population. This highlights the importance of better understanding and recognizing potential risk factors for suicide in this population and finding strategies to prevent it.

To investigate this question further, the researchers reviewed the clinical records of 609 patients with early-stage Huntington’s disease who were followed for more than 60 months while participating in the 2CARE clinical study (NCT00608881).

This phase 3 trial was conducted at 48 sites in the United States, Canada and Australia and was originally designed to explore the therapeutic potential of coenzyme Q10.

Of all participants, 52 (9%) reported having had at least one instance of suicidal ideation or attempt. Twenty-two suicide attempts occurred among 21 participants (3.4%) during the study follow-up period, with five completed events (0.8%).

In general, these patients had an increased incidence of active psychiatric diagnoses compared to patients who did not exhibit suicidal behaviors. Yet, this symptom had no significant impact on the patients’ total functional capacity.

Patients who had active depression, anxiety, or bipolar disorder at enrollment had 3.4, 2.3, and 6.0 times increased risk of suicidal behavior. Additionally, the use of antidepressant agents alone or in combination with anxiolytics has been associated with an increased risk of suicidal thoughts or attempts.

The researchers found that predictive genetic testing, as well as the severity of motor, cognitive, or functional symptoms, had no clinically significant contributory effect on suicidal behaviors in these patients.

In contrast, behavioral manifestations such as depressed mood, low self-esteem, anxiety, suicidal thoughts, irritability, and compulsive behavior have been shown to be significant contributors to suicidal ideation or attempt. .

“These data suggest [that] psychiatric comorbidities in Huntington’s disease are predictive of suicidal behavior when participating in clinical trials,” the researchers said. This reinforces “the importance of clinical monitoring and treatment to reduce risk during participation and perhaps beyond.”

The team thinks it might be important to develop a scoring algorithm to help predict early suicide attempts in this population. This tool could be of great relevance, as many trials of Huntington’s disease-modifying treatments are likely to be long-term.