Every thirteen minutes, we lose someone to suicide in the United States alone. For each of the victims we lose to suicide, another twelve are estimated to engage in a suicide attempt or self-injurious act. Suicide is the tenth leading cause of death in people of all ages.
Often, people think that suicide is only a risk in young men - but anyone can suffer, so if we see the signs, it's important to act, even if the person doesn't fit what we think of as the "typical victim."It may come as a surprise to most that the most suicides occurred in people between the ages of 45 and 64, but even more surprising is that the second highest at risk age group is people 84 and older. Although completed suicide is four times more common in males, attempted suicide is three times more common in females. No matter who is struggling, it is important that we understand the facts to get every person in pain the help that they both need and deserve.
Another common misconception is that suicide is committed by the "weak," or that these victims have simply taken the easy way out. I'll preface everything I'm about to say with this: suicide is never the answer, because life always seems hardest just before things start to fall into place. Although suicide is never the right option, just like any mental illness, it's hardly a choice. The biological mechanisms behind suicide, while not completely understood, have been studied extensively. Yes. Biological mechanisms. There are some people who simply have a greater risk of suicidal ideation and behavior in response to excessive stress. As someone who has struggled with this personally and has lost people to suicide, as well as an aspiring neuroscientist, I will whole-heartedly tell you it is not a matter of choice, but a matter of treatment.
Maybe it's difficult to believe that such a seemingly selfish and senseless act could be the result of biology and a lack of treatment, but the evidence is overwhelming. Imbalances in neurotransmitters, genetic alterations, immune responses, changes in functions and connections in the brain all play a role, along with endless social factors.
Neurotransmitters are chemicals that send messages in the brain - without them, cells in the brain wouldn't be able to communicate with each other nor with other cells in the body. They're incredibly important in everything from regulating your heart rate to giving you the butterflies when you go on a date. Keeping in mind just how important these little chemicals are in keeping you going, let's talk about how they've been found to be altered in those who commit suicide.
Serotonin, which is known as the "happy neurotransmitter" (and my favorite neurotransmitter) has been found to be altered in many mental disorders, including depression and suicidal behavior. So, biologically, what's the difference between being depressed versus being at risk for suicide? In both depressed and suicidal patients, neurons (brain cells) related to serotonin are underactive. The difference in suicidal patients compared to depressed patients in relation to serotonin, however, can be seen in two ways. First, the fluid within the spine has very low concentrations of serotonin in those that complete suicide, but this isn't true of depressed but non-suicidal patients. Second, it has been found that in those who commit suicide, serotonin is upregulated. It's thought that the brain is desperately trying to keep itself at baseline, but keeps falling short - the upregulation is thought to be compensating for a lack of serotonin in the brain, but it's also thought that this upregulation of serotonin associated with suicide is partially genetic. It's been found that serotonin genes are altered in those who commit suicide, and some genetic changes have been associated specifically with suicidal ideation but not completed suicide. These genes may explain why some people contemplate suicide while others complete it.
While serotonin has the most evidence to back its role in suicidal behavior and thoughts, there are other neurotransmitters that are just as important, if not more so, in understanding the biology behind suicide.
GABA, the neurotransmitter associated with inhibiting cell communication, is found to be highly dysregulated in victims of suicide. This decreased inhibition is seen in areas of the brain that are associated with emotion and planning which, just like serotonin alterations, are most likely caused by changes in genes. It is also thought that adrenaline, which is responsible for your fight-or-flight response, may play a role in suicidal behavior. Adrenaline has been found to be increased in those who commit suicide. Adrenaline is a fantastic neurotransmitter when you're facing a life or death situation, but when elevated during typical events, it can cause major problems. It's helpful to have a rush of adrenaline when a mother needs to lift a car off her struggling child, but what happens to that adrenaline when there's nothing life-threatening to face? In someone who commits suicide, it often correlates with much more violent ways of committing suicide.
Along with neurotransmitters, there are parts of the brains immune system that have been associated with higher risk of committing suicide.
Brain-derived neurotrophic factor (BDNF), a protein that's associated with plasticity in the brain. Plasticity is the ability to make changes between neurons, or the ability to "rewire" the brain so-to-speak. In people who attempt and commit suicide, BDNF is downregulated in many areas of the brain. It is thought that these changes may be associated with early-life adversity, almost as if the person is hard wired to think that life is going to be endlessly difficult. No one is completely sure how this is associated with suicidal behaviors. Hopefully, future research will shed some light on this. A lack of plasticity could be associated with the difficulty in changing the thought processes associated with suicidal ideation.
Individually, these alterations may be difficult to understand in relation to something as complex as suicide. When all of these changes come together, however, you start to see brain wide changes in brain connections and functions.
The frontal cortex (associated with planning, motivation and reward) and the amygdala (associated with emotions and emotional behavior) have been found to have altered functionality in those who commit suicide. It's even been found that the corpus callosum, which connects the two hemispheres of the brain together, is less defined in those who commit suicide. It would make sense that those who think it is necessary to end their lives would have different pathways for reward, planning and emotionality. These neural changes associated with suicide are often correlated with increased impulsivity, impaired decision making, increased attention to negative stimuli and decreased ability to problem solve. This is where it all starts to come together.
If you're anything like me (it's okay if you're not), you're starting to wonder why any of these changes would start to happen in the brain and body if they're so detrimental. There are a million speculations about why these things could happen, so I'll tell you about the one I find the most compelling - the immune system.
Most of us have heard that early-life adversity, incredibly high levels of stress or other social factors can influence your propensity for mental illness. It's been found that one of the most relevant predictors for suicide is feeling burdensome. All of these things are, of course, relevant - it's not nature versus nurture, it's nature plus nurture. Without some negative life events, it's much less likely that you'll struggle with mental illness, especially suicide. But what happens to cause it when you do experience some major life stress? When nature and nurture create the perfect storm of disaster?
The immune system has been thought to be that strange final factor that leads to suicide. The immune system is what causes inflammation, which is associated with all types of diseases like cancer - but could it be a major contributor in suicide?
It turns out, it just might be. For years, it boggled psychologists and neuroscientists why the highest rates of suicide peaked around March and April, right as spring rolled around. It's a common misconception that Christmas leads to peak suicide rates - it would make sense wouldn't it? Cold weather and lack of sunshine in tandem with having to deal with our sometimes intolerable (yet still lovable) families? Yet year after year, just as the hours of daylight start to climb, as do the rates of suicide. Some of this may be because as daylight hours begin to increase, those that had suicidal thoughts in the winter have the motivation to follow through without the increase in mood necessary to prevent depression and suicide.
Many are speculating, however, that this may be a function of immune inflammatory response. It's almost like the immune system is telling the body to abort the mission - to take their own life. Due to abnormalities in brain immune function commonly seen in victims of suicide, particularly in microglial cell function, the increase of allergens may just create the perfect storm to lead in increased suicide rates. It is thought that cytokines, which are released by those abnormal microglial cells when there is inflammation caused by things like an injury or an allergen, may have something to do with the changes in the frontal cortex. It's been found that in brains of those who commit suicide, there is increased cytokine density and other markers of immune response compared to healthy controls. While these connections are not yet completely understood, there is hope that this could help bridge that gaps in knowledge that currently exist in suicide research. Imagine preventing suicide by suppressing the immune system? It could be a pipe dream, but it could be a break through.
If you've learned nothing else from this, I hope that it helped you realize just how much research is still needed to understand suicide in order to prevent it. We understand the very basics of suicidal behavior, but more research will tell us how and why these changes came to be and how we can alter them toward normalcy for those that currently feel hopeless.
In the meantime, while we wait for that miracle cure, please take the time to participate in some way in Suicide Prevention Week. There is such a sense of shame behind the stigma of suicide that many simply don't want to admit that they are struggling. I never wanted to admit it until I came out on the other side, but many don't live to tell the tale. Talk about it. Say something if you think that someone might be struggling. Open up the conversation for someone that may not be able to. And please, if someone trusts you enough to open up, resist the urge to be angry, the urge to tell them that they are selfish for their struggles and just listen. Stop hiding from the issue and start talking about it.
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