MR Imaging of Drug-Induced Suicidal Ideation

D Marks, M Adineh, S Gupta

http://ispub.com/IJRA/9/1/10393

 The Internet Journal of Radiology. 2007 Volume 9 Number 1.

Abstract

Two patients with a history of suicidal ideation (SI) underwent functional MR imaging while undergoing treatment with interferon alpha 2 (IFN) for Hepatitis C virus infection (HCV). Patient #77 had a remote history of SI, but no current SI when treated with IFN. Patient #288 experienced an IFN-heightened SI, although she denied intent, a plan or a means. Visual stimuli were presented during functional MR imaging (fMRI) that were designed to invoke thoughts of suicide and violence. Patient #77 showed activation expected for visual stimulation alone, whereas patient #288 showed heightened activation for some of the visual stimuli with violent emotional content. Functional MR imaging shows promise to screen for a number of medication-induced CNS adverse effects (AE).

 

Introduction

Treatment of infections such as HCV with currently available medications can be associated with serious medical/clinical consequences, including psychological sequellae (prescribing information - PI). The use of interferon has been associated with SI (PI; Janssen et al., 1994; Fukunishi et al., 1998; Schafer et al., 2000; Ademmer et al, 2001; Bagheri et al., 2004; Dieperink et al., 2004; Laguno et al., 2004), although the incidence is not well-characterized (Helbling et al., 2002). The rate at which drug-induced SI progresses to a suicidal act is also not known. Other than avoiding use of IFN in individuals with significant underlying depression (Barraclough et al., 1974) or other risk factors for suicidal thought (CDC 2007), there is currently no reliable way to prevent an individual from responding to IFN by developing SI. It will therefore be of immense value to be able to predict and monitor in a quantifiable manner a clinically significant suicidal response to IFN in patients prior to the initiation of treatment, and also during the drug development cycle.

Functional neuroimaging has been successfully applied to the study of mood-disorders, including endogenous [Fu et al et al., 2004] and medication-induced (Marks et al., 2007a) depression, anxiety, and drug-seeking behavior. The application of fMRI for SI follows logically (Mann 2005). We have previously demonstrated (Marks et al., 2007a ) interesting differences between MR imaging of major depressive disorder (MDD) and that of medication-induced depression and anxiety, implying that the underlying causative mechanisms and treatment may differ. This report describes an initial effort to adapt fMRI to identify and monitor the course of SI induced by medications. This approach holds the potential of introducing new paradigms for understanding and treating SI.

Methods