Does Asthma Increase Adult Suicide Risk?

Study Shows Link Between Asthma and Suicidal Thoughts and Actions

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

May 14, 2008 — New research suggests a link between asthma and an increased risk for suicide attempts in adults, but not suicidal thoughts without attempts.

Compared to the general population, people in the study with asthma were roughly 50% more likely to attempt suicide after researchers controlled for established suicide risk factors, including depression and alcohol abuse.

Smoking cigarettes, which is a risk factor for asthma, was also found to be independently associated with an increased risk for suicide attempts. But this did not fully explain the link between asthma and attempted suicide.

The study is the first to examine the association between asthma and suicidal thinking — with and without suicide attempts — using a nationally representative sample of adults.

It did not address the issue of whether asthma treatment increases suicide risk — a topic that has been in the news since early this spring, when the FDA announced an investigation of a possible link between a widely prescribed allergy and asthma drug and suicide.

While many questions remain unanswered, researcher Diana E. Clarke, PhD, says doctors should be made aware of a possible link between asthma and suicide.

"Smoking and mental health illnesses like depression, panic disorder, and alcohol abuse were all associated with an increased risk for suicide [in the study], but when we controlled for these things the link with asthma was still there," she tells WebMD.

Asthma and Suicide

Clarke and colleagues examined data on 5,692 adults aged 18 and older participating in a nationwide health study between early 2001 and the spring of 2003.

Approximately 12% of the participants reported a history of asthma, 8.7% had experienced suicidal thoughts at some point in their lives, and 4.2% had attempted suicide.

Female sex, being a smoker, experiencing depression or anxiety, and alcohol abuse were all associated with an increased risk for suicide attempts in asthma patients, but none of these associations fully explained the asthma link.

More research is needed to confirm the association, but Clarke says asthma patients who express suicidal thoughts should be referred to mental health specialists.

The study appears in the May issue of the Annals of Allergy, Asthma and Immunology.

Allergy and asthma specialist Richard A. Nicklas, MD, of the George Washington Medical Center, describes the research linking asthma to suicide as preliminary and far from conclusive.

But he adds that his own patients seem to experience more depression during times when pollen counts are highest.

"That is anecdotal," he tells WebMD. "But what has been shown in studies is that there is a decrease in cognitive function — with more fatigue, irritability and difficulty concentrating — among patients experiencing [allergy and asthma] symptoms. Whether this is associated with something as serious as suicide, though, is another question."

Singulair and Suicide Risk

In March, the FDA announced that it would investigate reports suggesting a link between the asthma and allergy drug Singulair and suicidal thoughts and behaviors.

The agency asked that the drug's manufacturer, Merck, provide additional information on behavior and mood changes and suicidal thoughts and actions among patients who participated in Singulair studies.

It also urged health care providers and patients to report side effects experienced while taking Singulair and medications belonging to the same drug class known as leukotriene-modifiers, including the asthma drugs Accolate and Zyflo.

The FDA move was immediately questioned in a joint statement issued by two of the nation's top allergy and asthma groups: the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology.

"There are no data from well-designed studies to indicate a link between Singulair and suicide," the statement notes. "The concern expressed by the FDA is based entirely on case reports and there is no indication that such effects apply to other leukotriene-modifying medications."

Merck spokesman Ronald Rogers tells WebMD that the FDA action stems from "a very limited number" of case reports.

He adds that there were no suicides reported among 11,000 people who took part in more than 40 clinical trials of Singulair sponsored by Merck.

"The FDA clearly stated in its communication that patients with concerns should discuss them with their doctors," he says. "A patient's own physician is in the best position to determine whether or not this drug is an appropriate medication for them."

SOURCES: Clarke, D.E Annals of Allergy, Asthma & Immunology, May 2008; vol 100: pp 439-446. Diana E. Clarke, PhD, postdoctoral fellow and research associate, department of mental health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Richard A. Nicklas, MD, clinical professor of medicine, George Washington Medical Center, Washington, D.C. Ronald Rogers, spokesman, Merck & Co. Inc. FDA web site: "Early Communication About an Ongoing Safety Review of Singulair.""Joint Statement on FDA Investigation of Singulair from the AAAAI and ACAAI." WebMD Health News: "FDA Checks Into Singulair Suicide Risk."

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