Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior

Opinion statement

A high proportion of suicides visit their medical provider in the month prior to death, but depression, suicidal thoughts, and substance use are seldom addressed. For the clinicians routinely treating a substantial patient population with allergic diseases, there are additional concerns, as allergy has been linked with both depression and suicidal behavior. While psychotropic medications may affect diagnosis of allergies, medications used to treat allergies impact mood and behavior. Thus, we present an overview of the overlap of allergic rhinitis with depression and suicidal behavior in adults, based on clinical and epidemiological data, and our research and clinical experience. In summary, we suggest: (1) inquiring among patients with allergies about personal and family history of depression, substance use disorders, suicidal ideation, and attempts; (2) increased mindfulness regarding the potential effects of allergy medications on mood and behavior; and (3) for people identified with certain types of depression or increased suicide risk, a systematic multilevel collaborative approach. While, for practical reasons the majority of patients with depression will continue to be treated by general or family practitioners, the allergy-treating provider should always consider integrated care for bipolar, psychotic, or suicidal depression and incomplete remission, or relapsing and highly recurrent course. While awaiting results of a much needed basic and clinical research to guide the clinical approach to patients with comorbid allergic rhinitis and depression, the simple steps recommended here are expected to lead to improved clinical outcomes in depression, and, perhaps, contributing to lowering the highly resilient suicide mortality.Learning objectives: a) Present overlaps between allergy, allergen exposure, depression, and suicidal behavior in adults and b) Familiarize allergists with the principles of diagnosis and treatment of depression in adults and importance to monitor suicide risk.

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