Clin Psychopharmacol Neurosci 2019; 17(2): 318-322  
Alexithymia, Suicide Ideation and Homocysteine Levels in Drug Naïve Patients with Major Depression: A Study in the “Real World” Clinical Practice
Domenico De Berardis1,2, Luigi Olivieri1, Gabriella Rapini1, Serena Di Natale1, Nicola Serroni1, Michele Fornaro3,4, Laura Orsolini4,5, Alessandro Valchera4,6, Alessandro Carano7, Federica Vellante1,2, Paola Annunziata Varasano8, Gabriella Lucidi Pressanti8, Gianluca Serafini9, Maurizio Pompili10, Giovanni Martinotti2, Massimo Di Giannantonio2
1National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, Teramo, 2Department of Neurosciences and Imaging, University “G. D’Annunzio”, Chieti, 3Department of Psychiatry, Federico II University, Naples, 4Polyedra, Teramo, Italy, 5School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK, 6Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, 7Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “Madonna Del Soccorso”, National Health Service, San Benedetto del Tronto, 8Department of Immunohematology and Transfusional Medicine, “G. Mazzini” Hospital, Teramo, 9Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, 10Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
Correspondence to: Domenico De Berardis, MD, PhD National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, p.zza Italia 1, 64100 Teramo, Italy
Tel: +39-0861429708, Fax: +39-0861429709 E-mail: domenico.deberardis@aslteramo.it; dodebera@aliceposta.it
ORCID: https://orcid.org/0000-0003-4415-5058
Received: February 28, 2018; Revised: May 6, 2018; Accepted: July 27, 2018; Published online: May 31, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: This study was performed to elucidate relationships between alexithymia, suicide ideation and homocysteine levels in drug-naïve outpatients with major depressive disorder (MDD).
Methods: Sixty seven outpatients with MDD with melancholic features were evaluated by the means of the Hamilton Depression Rating Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation, and homocysteine levels.
Results: Alexithymic subjects showed higher scores on all scales and higher homocysteine levels. Regression analysis shown higher homocysteine levels and TAS-20’ “Difficulty in Describing Feelings” dimension, in turn being associated with higher suicide ideation.
Conclusion: In conclusion, alexithymic MDD outpatients may characterize for homocysteine dysregulation that may be linked to suicide ideation, regardless depression’ severity. However, study limitations are discussed and must be considered.
Keywords: Affective symptoms; Alexithymia; Depression; Suicidal ideation; Homocysteine.


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