Current Treatment Options in Allergy

, Volume 4, Issue 1, pp 71–97 | Cite as

Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior

  • Ameya U. Amritwar
  • Christopher A. Lowry
  • Lisa A Brenner
  • Andrew J. Hoisington
  • John W. Stiller
  • Robert Hamilton
  • Teodor T. PostolacheEmail author
Allergic Rhinitis (J Máspero, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Allergic Rhinitis

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.


Allergic rhinitis Depression Inflammation Suicidal behavior Suicidality 



This article is supported by the Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Tuning Inc., Silver Spring, MD, USA; and the DC Department of Mental Health, St. Elizabeths Hospital Residency Training Program, Washington, DC, USA. Key data presented in this study have resulted from projects supported by R01MH074891 (PI Postolache) from the National Institute of Mental Health, National Institutes of Health, Bethesda, MD. The authors thank Ms. Aline Dagdag and Dr. Naila Karim for their comments on an earlier draft of the manuscript and Ms. Winny Mwaura for her excellent administrative support. The opinions expressed in the article are of the authors and do not represent official positions or views of the National Institutes of Health, or the US Department of Veterans Affairs.

Compliance with Ethical Standards

Conflict of interest

Dr. Christopher A. Lowry is a member of the Scientific Advisory Board of Immodulon Therapeutics, outside of the submitted work. Drs. Ameya U. Amritwar, Lisa A Brenner, Andrew J. Hoisington, Robert Hamilton, John W. Stiller, and Teodor T. Postolache declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not present any primary data based on human or animal data beyond those previously presented before, appropriately acknowledging human subject and animal rights issues.

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Copyright information

© Springer International Publishing AG (outside the USA) 2017

Authors and Affiliations

  • Ameya U. Amritwar
    • 1
    • 2
  • Christopher A. Lowry
    • 3
    • 4
    • 5
  • Lisa A Brenner
    • 4
    • 5
    • 6
  • Andrew J. Hoisington
    • 4
    • 7
  • John W. Stiller
    • 1
    • 2
  • Robert Hamilton
    • 8
  • Teodor T. Postolache
    • 1
    • 4
    • 5
    • 9
    Email author
  1. 1.Mood and Anxiety ProgramUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Saint Elizabeths Hospital-DBH Psychiatry Residency Training ProgramWashingtonUSA
  3. 3.Department of Integrative Physiology and Center for NeuroscienceUniversity of Colorado BoulderBoulderUSA
  4. 4.Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE)DenverUSA
  5. 5.Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)DenverUSA
  6. 6.Department of Psychiatry, Physical medicine and Rehabilitation, and NeurologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  7. 7.Department of Civil and Environmental EngineeringUS Air Force AcademyColorado SpringsUSA
  8. 8.Division of Allergy and Clinical Immunology, Department of MedicineJohns Hopkins Asthma and Allergy CenterBaltimoreUSA
  9. 9.VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreUSA

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