Psychiatric Disorders Raise Risk of Suicidal Behavior in HD Trial Participants

Psychiatric Disorders Raise Risk of Suicidal Behavior in HD Trial Participants

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

The study, “Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial,” was published in Neurology.

Huntington’s disease is mostly recognized for its motor symptoms, including impaired gait and muscle rigidity, but patients can also experience behavior, cognitive, and psychiatric disorders.

Suicidal behavior, in particular, can affect up to 20% of symptomatic and pre-symptomatic patients. Suicide is 12 times more frequent among Huntington’s patients compared to 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 further explore this issue, researchers reviewed the clinical records of 609 patients with early Huntington’s disease who were followed for over 60 months during their participation in the 2CARE clinical study (NCT00608881).

This Phase 3 trial was conducted in 48 locations in the U.S., Canada, and Australia, and was initially designed to explore the therapeutic potential of coenzyme Q10.

Of all participants, 52 (9%) reported to have had at least one instance of ideation or attempt of suicide. 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 increased incidence of active psychiatric diagnoses compared to patients who did not have suicidal behaviors. Still, this symptom had no significant impact on patients’ total functional capacity.

Patients who had active depression, anxiety, or bipolar disorder at enrollment were found to have 3.4, 2.3, and 6.0-fold increased risk of suicidal behavior. Also, the use of antidepressive agents alone or in combination with anxiolytics was associated with an increased risk of suicide ideation or attempt.

The researchers found that undergoing predictive genetic testing, as well as motor, cognitive, or functional symptoms’ severity, had no clinically meaningful contributing effect regarding suicidal behaviors among these patients.

In contrast, behavioral manifestations such as depressed mood, low self-esteem, anxiety, suicidal thoughts, irritability, and compulsive behavior were found to be important contributors to suicidal ideation or attempt.

“These data suggest [that] psychiatric comorbidities in Huntington’s disease are predictive of suicidal behavior while participating in clinical trials,” researchers stated. This reinforces “the importance of clinical surveillance and treatment toward lessening risk during participation and perhaps beyond.”

The team thinks it could be important to develop an assessment algorithm to help predict suicide attempts early on in this population. This tool could be of major relevance, as many trials for Huntington’s disease-modifying therapies are likely to be long-term.

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