An article by Auerbach et. al (2021) references Vidal-Ribas and colleagues, in a challenging study of identifying possible biological markers that confer risk for suicidal behaviors in preadolescent youths. The strongest neural correlate discovered was an association between suicidal thoughts and behaviors and decreased thickness of the superior temporal gyrus.
The last approach in terms of research and suicide prevention in the Mann & Rizk article talks medication and neuromodulation. Mann & Rizk suggest the use of buprenorphine, a medication used primarily for relapse prevention in opioid use disorder, this, the buprenorphine also has antidepressant effects when used for both its intended use and for depression that has been found to be treatment resistant. By addressing both opioid relapse and comorbid depression and suicidality, it could be further evaluated if it’s a possible way to reduce suicide risk via opioid overdose.
In terms of neuromodulation, there have been preliminaries studies have also indicated a decrease of suicidal ideation following treatment with rTMS or repetitive transcranial magnetic stimulation. Also, the role of inflammation in the pathogenesis of depression and suicidal behavior suggests use of anti-inflammatory drugs for depressive symptoms and suicidal ideation. Even though, none have shown to improve suicidal ideation, minocycline has been able to decrease microglial activation in the Prefrontal cortex & depressive and anxiety-like traits in animals so it may reduce depressive symptoms.
A study by Hamilton & Buysse (2019) references McCall et al. whose REST-IT study, that is R-E-S-T-dash-I-T study which examined controlled-release zolpidem relative to placebo serves as a benchmark for future studies conducting randomized controlled trials of suicidality with outpatients. This study also saw reductions in insomnia, depression, and suicidality, which supports the utility of targeting insomnia in suicide prevention efforts.
The Mann & Rizk article also told us that no drugs targeting HPA axis dysregulation have been evaluated for the use of preventing suicide. The glucocorticoid receptor antagonist mifepristone and cortisol synthesis inhibitors such as metyrapone and ketoconazole have not shown distinct benefit for depression but may warrant testing in suicidal individuals with glucocorticoid hypofunction.
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In closing, I hope you’ve enjoyed this podcast. And that by giving you a brief glimpse, and believe it or not, this has been a brief glimpse into all the research that has been done and is being done on suicide prevention. And that you’ve seen how suicidal behavior is a real risk that prevails at all ages for both men and women. It’s a phenomenon that involves various biological and psychosocial factors, and although there is a lot of ongoing studies related to identifying its most prevalent biological risk factors as well as treatments, there is still a growing need for further research to successfully develop effective suicide prevention methods that would help decrease global suicide rates. As I said in the beginning, close to 800,000 people die each year from committing suicide. It’s not a problem that can be ignored. Thanks for listening and I hope you have a nice day.