Anti-depressant drugs and cognitive behavioural therapy seem to reduce suicidal thoughts for many people with depression – but they are not a perfect cure for every patient. Why some respond, while others don’t, has been the matter of much soul searching, but recent research is helping to shed a little light on this dark state of mind. For instance, there is a growing recognition that the disease we call “depression” could be an umbrella-term covering many distinct problems, each with a different biological origin. In particular, a suicide attempt may be foreshadowed by a string of neurological changes that are not found in people with other kinds of depression. Of the most noticeable differences, patients who have tried to kill themselves seem to have less of the white-matter connections that transmit information in the dorsomedial prefrontal cortex – the part of the brain right behind your forehead’s hairline. That’s significant, since this region helps us process our self-awareness.
People who try to kill themselves seem to get stuck in ruminative, negative styles of thinking full of self-criticism – so I wonder if the neurological changes could lie behind those destructive trains of thought, blinding people to the hope and promise of the future, and even of their sense of their own self-worth.
People feeling suicidal thoughts also seem to have reduced connectivity in the frontal areas of the brain associated with emotional control and inhibition. Suicide is considered to be an impulsive action, so it could be that the abnormal wiring in these regions makes it harder for someone to cope with the urge for self-destruction. On top of these specific changes, the brain cells themselves seem to be wasting away across diverse regions of the brain, potentially impairing problem solving and decision making – cognitive problems that are commonly seen in people who have attempted suicide.
At the moment, it’s not clear what triggers these anatomical changes and whether they are the primary cause of the suicidal urges – it could be that they are just a side-effect of the depressed, desperate feelings that the patient is already experiencing. Most likely, the psychological symptoms and the altered brain wiring are both the result of a complex interplay between your genes and your circumstances.
Many suicidal patients are unlikely to tell anyone, even their doctors, about their darkest feelings – but a brain scan might reveal those characteristic anatomical changes, giving doctors an insight that they couldn’t have gained from an interview. Since neural degeneration – such as the death of neurons – has certain chemical signatures, some have suggested that blood tests could one day reveal the early signs that could precede a suicide attempt.
Once the patients’ particular needs have been identified, the work could then tailor treatments that best suit the particular type of depression they have. Doses of lithium, for instance, seem to replenish the grey matter in damaged areas of the suicidal brain; and studies have found that the drugs do indeed reduce the risk of a second suicide attempt, when applied to people with bipolar disorder who have already attempted to take their life once.
Kees van Heeringen at the Unit for Suicide Research in Ghent University in Belgium has proposed that upcoming, non-invasive forms of brain stimulation like Transcranial Magnetic Stimulation (TMS) could also be of interest. Using a magnet on the scalp, TMS can boost or reduce the electrical activity in specific parts of the brain. It has already helped bring relief to people with other kinds of depression that had resisted treatment, and it could potentially target the regions most affected in people with suicidal feelings, curtailing their destructive urges.
It is unlikely that any single treatment will ever be a panacea for people suffering from severe and suicidal depression. If you feel suicidal yourself, or know someone who might be, the advice is to seek medical help as soon as possible.
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