Precision Medicine in Suicide

“Individuality in universality is the plan of creation.”

Swami Vivekananda

Suicide is a phenomenon that is growing rapidly in Mexico. In 2021, there were 8,351 deaths from self-inflicted injuries in the country, which represents a suicide rate of 6.5 per 100,000 inhabitants. Of the deaths from this cause, it stands out that men have a rate of 10.9 suicides per 100,000 (6,785). The rate for women is lower: 2.4 per 100 thousand (1,552). Men between the ages of 15 and 29 are the group with the highest risk, since 16.2 suicides occur for every 100,000 men between these ages.

The International Association for Suicide Prevention and the World Health Organization instituted September 10 as World Suicide Prevention Day. The objective is that nations implement and promote actions for their prevention and that commitments and practical measures to prevent them are promoted throughout the world.

Precision medicine is defined as “an emerging approach to treatment and prevention that takes into account each person’s variability in terms of genes, environment, and lifestyle,” and will make it possible to choose the right treatment for the right person at the right time. correct timing based on a unique individual neurobiological biosignature.

A search in the Pubmed database of the National Library of Medicine of the National Institutes of Health with the descriptor in the title of “Precision Medicine” and in other fields the descriptor “Suicide” shows 11 articles, the first from 2017 and four last year, showing a trend of more research reports.

For María Luisa Barrigón and collaborators from the Department of Psychiatry of the Hospital Fundación Jiménez Díaz, Madrid, Spain, the evidence is compelling: if we want to stop this upward trend in suicide as a society, a better understanding of the phenomenon of suicide is needed. Precision medicine is a promising approach to this goal, and an opportunity for the role that digital health could play.

One example is recent findings with technological advances such as smartphone-based ecological momentary assessment and passive collection of information from sensors, providing a detailed description of suicidal thoughts and behavior.

In addition, in the more traditional approaches in the field of genetics, the need for precision medicine in suicidology is highlighted. Then, in the light of recent and promising research, the role of smartphone-based information collection using explicit (active) and implicit (passive) means to construct a digital phenotype should be examined, which should be integrated with genetic and epigenetic data to develop personalized therapies and preventive approaches to suicide.

In another publication, Pinna de Graziano from Switzerland argues that diagnostic accuracy, prediction and prevention of psychiatric disorders, including major unipolar depression, post-traumatic stress disorder (PTSD) and suicidal thoughts and attempts, remain areas of interest. underdeveloped in psychiatry due to the general lack of biomarker evaluation. This makes it unlikely that precision drugs will be developed for these debilitating conditions, creating an area of ​​opportunity for urgently needed research in neuropsychopharmacology.

In fact, he anticipates that the discovery of biomarkers will greatly improve the refinement of individualized medicine that currently relies on subjective assessment of symptoms, based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). . To highlight the magnitude of the problem and probable solution, it is stated that both depression and post-traumatic stress syndrome are highly prevalent conditions, affecting 3% to 12% of the general population and are one of the main causes of disability.

Mood disorders are characterized by sadness, anhedonia -inability to feel and experience pleasure- and disturbed concentration; while the symptoms of post-traumatic stress include avoidance of traumatic memories, hyperarousal, hyperreactivity, flashbacks -memories of previous scenes- and nightmares. For sufferers, “gold standard” antidepressant treatment only improves symptoms in half of patients. Thus, the development of reliable biomarkers holds the hope or promise of predicting the best outcomes for those subjects who are most likely to respond to an individually designed treatment rather than a “one-size-fits-all” treatment.

Finally, H Le-Niculescu H. from the department of psychiatry at the Indiana University School of Medicine in the United States, reports his effort to identify objective gene expression biomarkers in blood for psychological stress, a subjective sensation with biological roots. . One of these was FKBP5, a well-known gene involved in the stress response, which serves as a reassuring de facto positive control. Furthermore, more than half of the main predictive biomarkers of stress also had prior evidence of suicide involvement, and most of them had evidence in other psychiatric disorders, providing a molecular basis for the effects of stress on those disorders. The hope is that some of the biomarkers are existing drug targets, of potential utility in patient stratification and pharmacogenomic approaches to suicide prevention, and that’s the good news. Hopefully in our country, with such prestigious institutions as the National Institute of Genomic Medicine and the National Institute of Psychiatry, they will already take action on the matter and help solve this serious social problem. Merry Christmas and see you in January 2023!

*The author is a surgeon, specialized in public health, doctorate in health sciences and public administration, and is a re-elected deputy of the PAN parliamentary group in the LXV Legislature.