We are pleased to host Dr. Maria A. Oquendo, M.D., Professor of Psychiatry and Vice-Chair at Columbia University and New York State Psychiatric Institute, as a panelist for the 2016 Fountain House Symposium and Luncheon. Our distinguished guest holds a variety of posts including President-Elect at the American Psychiatric Association, President-Elect at the International Academy of Suicide Research, and Vice-President of the American Foundation for Suicide Prevention’s Board of Directors. Dr. Oquendo’s expertise spans from pharmacology and neurobiology of mood disorders and suicidal behavior to Global Mental Health (GMH). She is principal investigator on several NIMH studies, including a prospective study of suicidal behavior.
We asked her to explain the research she does on biomarkers (measurable indicators of the presence of disease or disease risk) as neurobiological predictors of suicide.
FH: Can you give us an idea of the research you do in finding a biological marker that links to suicide attempts?
MO: One of the things we’re very interested in doing is trying to identify probably what will end up being not just one biomarker, but a panel of biomarkers, that will help us figure out who’s at risk. It’s not so different from what cardiologists use. You go to your cardiologist and they’ll do an EKG, and they’ll check your cholesterol and they’ll see if you have diabetes, and all of these things put together help them construct a risk profile.
FH: What are some of the biomarkers for suicide risk?
MO: Some of the logical places to look have to do with the stress response system. So for example, we know that in suicidal individuals, they have abnormal hormonal reactions to stress. And we can measure this, we can set up experiments in which we have the individual participate in an interview that is stressful for them, and we can measure their hormone response and see how they react not only biologically, but we also ask them about their subjective experience to see the relationship between the hormonal response and what their subjective experience is.
FH: Are the biomarkers the same across diagnoses? As in, the neurobiological patterns are the same in a person who died by suicide who was diagnosed with major depression as one with schizophrenia?
MO: The best way to address that type of question is to look across different diagnoses. There are only a handful of studies so far that have done something similar, which is to pool together individuals who have died by suicide who have a variety of diagnoses and to look for commonalities within that group as compared to, say, individuals who are not dying by suicide but who also have pathology. But until we have the opportunity to look across different diagnoses to see if we can identify the same kinds of abnormalities, it’ll be difficult to determine with certainty that it’s the same biological abnormality in schizophrenia, for example, as it is in depression.
FH: So currently there’s no way to study biomarkers across diagnoses?
MO: Well, another way to get at the problem is by studying individuals who have a particular psychopathology, let’s say, like depression, and compare individuals who have suicidal behavior, to those who do not. Or the brains of individuals who have died by suicide and were depressed at the time of death, and individuals who were depressed at the time of death but did not commit suicide. That also allows us to get at the underlying neurobiology of suicide quite apart from whatever’s affecting the physiology, or whatever’s causing the pathology.
FH: What are the major challenges of this research?
MO: Oftentimes in research programs, you don’t have necessarily the opportunity to do cross-cutting research like that where you’re looking at a variety of people who present for clinical care and to look at a particular issue, for example, related to suicidal behavior, regardless of what their pathological condition is. And I think one of the things that is a big challenge for us in the field is that even though we are interested in understanding the pathophysiology of a particular problem, let’s say suicide or major depression, they usually are conditions that don’t happen by themselves. Because the majority of people who have psychiatric problems have multiple conditions.