Increased fear-potentiated startle in major depressive disorder patients with lifetime history of suicide attempt

Elizabeth D. Ballard, Dawn F. Ionescu, Jennifer L.Vande Voort, Elizabeth E. Slonena, Jose A. Franco-Chaves, Carlos A. Zarate, Christian Grillon

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background Suicide is a common reason for psychiatric emergency and morbidity, with few effective treatments. Anxiety symptoms have emerged as potential modifiable risk factors in the time before a suicide attempt, but few studies have been conducted using laboratory measures of fear and anxiety. We operationally defined fear and anxiety as increased startle reactivity during anticipation of predictable (fear-potentiated startle) and unpredictable (anxiety-potentiated startle) shock. We hypothesized that a lifetime history of suicide attempt (as compared to history of no suicide attempt) would be associated with increased fear-potentiated startle. Methods A post-hoc analysis of fear- and anxiety-potentiated startle was conducted in 28 medication-free patients with Major Depressive Disorder (MDD) divided according to suicide attempt history. Results The magnitude of fear-potentiated startle was increased in depressed patients with lifetime suicide attempts compared to those without a lifetime history of suicide attempt (F(1,26)=5.629, p=.025). There was no difference in anxiety-potentiated startle by suicide attempt history. Limitations This is a post-hoc analysis of previously analyzed patient data from a study of depressed inpatients. Further replication of the finding with a larger patient sample is indicated. Conclusions Increased fear-potentiated startle in suicide attempters suggests the role of amygdala in depressed patients with a suicide attempt history. Findings highlight the importance of anxiety symptoms in the treatment of patients at increased suicide risk.

Original languageEnglish (US)
Pages (from-to)34-38
Number of pages5
JournalJournal of Affective Disorders
StatePublished - Jun 20 2014


  • Fear-potentiated startle
  • Major depressive disorder
  • Suicide

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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