Association between cytokine levels and SSRI-emergent suicidality
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Association between cytokine levels and SSRI-emergent suicidality There appears to be an association between increased levels of the cytokine interleukin-6 and suicidality in paediatric patients receiving the selective serotonin reuptake inhibitor (SSRI) fluoxetine, according to study results reported in European Neuropsychopharmacology, but only in children with pretreatment suicidality. The study investigated 92 patients with major depressive disorder and/or anxiety disorders who received fluoxetine 20–40 mg/day. There were 57 girls and 35 boys, with a median age of 13.90 years. At the 6-month follow-up visit, 50 children were still receiving fluoxetine, while the remaining patients had been switched to another SSRI. There was no significant change in tumour necrosis factor-α levels during the study. However, there were significant increases in both interleukin-6 (IL-6) levels (False Discovery Rate correction p=0.012) and interleukin-1β (IL-1β) levels (p=0.006). There were no differences in patients who continued fluoxetine compared with those who switched to other SSRIs. There were 62 patients who had a non-zero Columbia Suicide Severity Rating Scale (C-SSRS) grade at baseline (39 girls and 23 boys, median age 14.27 years), indicating a high-risk group with pretreatment suicidality. There were significant increases in IL-6 (p=0.025) and IL-1β (p=0.003) for these patients, but no significant increases for the children without pretreatment suicidality. There were 16 high-risk children (26%) who developed clinically meaningful suicidal behaviours (SBs), comprising a suicide attempt (n=7), worsening suicidal ideation (n=4) or worsening or new onset non-suicidal self-injury (NSSI; n=5). There were no age, sex, diagnostic, baseline cytokine level or tested clinical parameter differences between those who did and did not develop SBs. Significantly increased IL-6 levels only occurred in children who developed SBs (p=0.006), which the authors note "is suggestive of an enhanced inflammatory response in these children despite the SSRI treatment". "Our study underscores circulatory IL-6 as a potential inflammatory biomarker of specific importance in the pathophysiology of SSRI-associated SB", note the authors. "It seems that in children prone to suicidality associated with SSRI treatment, there is an incapability of SSRI to suppress elevation in IL-6 synthesis", they add, "and persistent accumulation of the cytokine may lead to SBs". Amitai M, et al. An increase in IL-6 levels at 6-month follow-up visit is associated with SSRI-emergent suicidality in high-risk children and adolescents treated with fluoxetine. European Neuropsychopharmacology : 31 Jul 2020. Available from: URL: http://doi.org/10.1016/j.euroneuro.2020.07.007
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Reactions 22 Aug 2020 No. 1818
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