Suicide attempts in depressive disorders and the hypothalamic pituitary adrenal axis. Is it a tool for suicide prediction?

A non-fatal suicide attempt is the strongest known clinical predictor of eventual suicide. Approximately 15-20% of depressed patients commit suicide despite maintenance therapy with antidepressant medication. The aim of the present study was to evaluate the role of the hypothalamic pituitary adrenal [HPA] axis in cases of attempted suicide through hormonal assay and adrenal ultrasonography in an attempt to provide a useful tool to predict suicide and perhaps prevent suicidal behavior in patients with major depressive disorders. Thirty patients with major depression who recently attempted suicide were included. The seriousness of the suicide attempt was assessed according to the Suicide Intent Scale [SIS] which ranged from 25 to 29 in the depressive patients indicating a high suicidal intent. The number of male patients exceeded the number of female patients and the mean age of the patients was 34.4 +/- 5.86 years. The methods used in suicide included; drug overdose, cut wrist, jumping off balcony and gas inhalation. Drug overdose accounted for the majority of the cases [76.66%]. The plasma adrenocorticotrophic hormone [ACTH] levels in the patients' studied group were significantly lower than those of the control group while the plasma cortisol level was significantly higher than the control group. Patients also showed a significantly lower cholesterol plasma level than controls. Regarding adrenal ultras onography results, the adrenal gland size in depressives was significantly larger than the adrenal gland size of their matched controls, where 17 of the patients had an enlarged adrenal gland. It is concluded that there is a relation between stress, depression and the HP A axis. The results in this study may help clinicians identify suicide vulnerable individuals. The findings may also help in the postmortem identification of suicide victims, during autopsy, through nonpathological adrenal enlargement