B O S T O N, Jan. 28
What causes people to commit suicide? The impulse may be genetically triggered. Canadian scientists have found a gene mutation that they say doubles to triples the risk that depressed people will have suicidal thoughts.

"If somebody has this predisposition and nothing bad ever happens to them, it may never be expressed," says study co-author David Bakish, a professor of psychiatry at the University of Ottawa and head of the psychopharmacology clinic at the Royal Ottawa Hospital. "But if they lose their job or whatever, then it may come into play."

A Mood Gene

The gene in question makes a receptor for serotonin, a brain chemical known to affect mood. Out of 120 patients diagnosed with major depressive disorder, the researchers found the mutated gene in 35 percent, twice as often as they found it in normal patients. What's more, among the depressed patients, the ones with suicidal thoughts were the most likely to have the mutation.

Steven Moldin, chief of the genetics research branch at the National Institute of Mental Health, cautions that results like this have not panned out in the past. In fact, Moldin, who is on the board of the American Journal of Medical Genetics, where this study will appear, said that several years ago, board members voted on whether or not to allow studies of this type, known as case-controlled associations, into the journal.

In the end, the board voted yes. But because of inherent weaknesses in the study design, Moldin says, the true test will be to see if other labs can confirm the results.

But it raises the possibility, says Brian Clark, director of medical genetics at the Cleveland Clinic Foundation, "that in some families [serotonin imbalances] may not just manifest as depression or schizophrenia, but may manifest as a predisposition to suicide."

Suicide Test Ahead

That suicidal thoughts may be distinct from other mental illnesses, Bakish says, means that the discovery may lead to a "suicide test" to identify those who are at risk. People often come into emergency rooms with suicidal thoughts, he says. "With a test, you could say, You have this mutation, you are at higher risk. Maybe you'd benefit from long-term treatment."

And unlike some other genetic conditions, like Huntington's disease, for which there is a test but no cure, suicidal thoughts can be virtually eliminated with drugs like Prozac.

"Because it's so treatable," Bakish says, "patients who are treated are as well or better off than general population."

The Stigma of Suicide

Nevertheless, the prospect of a gene for suicide risk, and perhaps a test, raises thorny ethical issues. Suicide is the ninth-leading cause of death in North America, and any predictor for suicidal tendencies might jeopardize a person's life insurance coverage. Certainly, the potential for stigmatization is enormous.

"On other hand," Clark says, "there's a tremendous possibility to do good." Children who may be susceptible to suicide, he says, could be identified early and kept on watch.

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