Know someone who’s suicidal? Or…how about this? Do you know someone you think might be?
Is there someone in your life who’s always down, irritable, short-tempered… even jumpy, maybe? Maybe you wish they’d adjust their attitude, or take a chill pill. Sometimes, people can be like this and the problem is that they might be depressed. Or they may suffer from PTSD and even be suicidal. There are some researchers at Yale who are trying to identify biomarkers for PTSD and suicidal thinking. More about that in a moment, but first let’s talk about PTSD.
Some 8% of people will meet criteria for PTSD at some point in their lives. Those who have fought in active combat have roughly a 40% likelihood of receiving a PTSD diagnosis. But there are other life events that can also lead to PTSD such as sexual assault, domestic violence, cancer treatment, a child’s devastating illness, or a serious transportation accident, for example.
The DSM-5 sets the criteria for diagnosis of psychiatric disorders. It says there are several criteria required to diagnose someone with PTSD:
First, you must have been exposed to the threat of death or serious injury or sexual violence directly, or by witnessing it, or learning someone close to you experienced it. Or by indirect exposure as a first responder.
Second, you have to re-experience this traumatic event by reliving memories, or in nightmares, or maybe you suffer distress when you’re faced with a traumatic reminder of what happened.
Third, you likely make effort to avoid situations that would remind you of the traumatic event, or to think thoughts that pull you back into the painful memories of it.
Fourth, you have negative thoughts or feelings that resulted after the trauma. Like blaming yourself or others, shaming yourself, holding a negative attitude, and isolating yourself. You have lost interest in doing things you used to enjoy or getting out with friends. Does any of this sound familiar? Stay with me…because there’s hope coming…
Further, you find that you react to things that happen differently than you used to. Like you feel irritable and aggressive, or you may embrace high risk activities, or you may feel hyper-vigilant…always on edge for something to happen. Plus it’s hard to sleep or stay asleep, and it’s hard to concentrate. You’re likely to experience depression, anxiety, possibly substance abuse in an effort to avoid thinking about the traumatic experience.
Obstacles to Functioning
If you’re diagnosed with PTSD, these symptoms have lasted awhile and your doctor must know that you haven’t used other medications or illicit drugs that could have caused this.
PTSD isn’t just feeling bad about something that happened. It’s a reaction inside you to something terrifying that changes the way you think and feel and respond to life. It changes your body… and your environment. Because it changes the way your mind interprets what you see, smell, hear, taste, and feel.
How Fear is Connected to Suicidal Thinking
The Brain and Behavior Research Foundation recently offered a webinar about the work they’re funding with regard to PTSD, suicidality, and IV ketamine treatment. Lynnette A. Averill, Ph.D., Assistant Professor of Psychiatry at Yale University, explained the link between the fear and anxiety people with PTSD have and how it’s connected to suicidal thinking.
Three Regions of Your Brain are Key
So let’s talk about your brain, and how PTSD affects it. There are multiple parts of your brain that play a role in your experience as part of this disorder. And the trauma that caused this disorder triggered multiple changes in your brain. The prefrontal cortex, the amygdala, and the hippocampus are the primary areas involved, and what Dr. Averill’s team focused on.
The prefrontal cortex regulates our emotions and helps us make decisions related to them. The amygdala helps us with fear processing. And the hippocampus helps us interpret emotional context.
These three regions aren’t the only regions involved in PTSD, but they’re the most consistently significant.
The hippocampus loses volume when you’re traumatized. So as PTSD increases and its symptoms increase, too, the volume of the hippocampus decreases.
The prefrontal cortex thins in the presence of trauma. In fact, the more severely traumatized you are, the thinner the tissues in the prefrontal cortex. It makes the decision whether you’ll fight, run, or chill.
And the amygdala hyper-reacts. So it goes like this. Let’s say a T-Rex stomped down your street and through your yard. You look out the window and see his knees. Immediately, your amygdala sends out the alarm and calls upon adrenalin to scream, “FIGHT or FLIGHT!!”
PTSD Changes Brain Function
The job of the prefrontal cortex (PFC) is to call up the amygdala on speed dial…and tell him “Nothing’s wrong... It’s a hologram. Go back to your cable show… Everything’s ok.” And the amygdala settles back into his recliner.
Because PTSD doesn’t just change the way the brain areas look, it also changes the way they function…and so, in turn, the way YOU function.
Now here’s the thing. People who are suicidal have impaired executive function. This means that the organization, ability to focus and pay attention to others, as well as regulating emotion and disciplining yourself in a way that helps you meet goals…well, none of that is working well enough.
It means you’re likely scattered, and probably unpredictable. Maybe impulsive. The impairment of these abilities sets you at greater risk for making a tragic and impulsive final decision.
Is Suicide Rare?
Suicide is the 10th leading cause of death in the US across all age groups. To make that a little easier to grasp, think of it this way: 129 people take their own lives every single day in this country.
In 2016, suicide was the 2nd leading cause of death for people aged 10 to 24. More than leukemia, or fire, or overdose.
This is aside from the numbers for middle aged adults or the elderly. This includes children only 10 years old! And we need to better understand any biomarkers that can help us identify those who are at higher risk to even attempt suicide.
And it gets worse. Veterans are 1.5 to 2 times at higher risk for suicide. Sexual minorities are also at increased risk for suicidal thoughts and behaviors. The numbers include those individuals who suffer from bipolar disorder and have a 5 times greater risk for suicidal behaviors.
So this brings up this point. We need something to point to that’s common to all these conditions. Dr. Averill believes the link is synaptic growth.
Actually, it makes sense, doesn’t it? When synaptic growth stops, and synapses break down and thin out, you’re more likely to experience depression, anxiety, and PTSD along with other disorders that are stress-based. And when you treat this synaptic deficit, the symptoms of these disorders tend to dissipate.
Ketamine Treatment Restores Synaptic Growth and Just May Be a Biomarker for PTSD and Suicidal Thinking
The most effective treatment for these disorders is likely something that restores synaptic growth. Furthermore, that something needs to act rapidly, because there is the risk these patients may make suicidal attempts.
It just stands to reason, doesn’t it?
Well, it so happens that IV ketamine treatment does just that, and fast.
It switches on mRNA which turns on DNA to turboboost brain-derived-neurotrophic-factor (BDNF) to rapidly proliferate new synapse connections with their dendrites and dendritic spines all through the brain. It also slides the G proteins off their lipid rafts in the brain cell membranes, so they can productively go to work enhancing signaling along these new synapse connections. And within 24 hours you can feel amazingly better. Or it might take you a few days depending on your brain and genetic makeup.
But traditional antidepressants take weeks or even months… in many cases it can be three or four. And far too many people struggling with intrusive suicidal thoughts have ended their lives by then. That’s why it’s so extraordinary that ketamine is a RAAD (rapid-acting-antidepressant) rather than a SAAD (slow-acting-antidepressant).
Ketamine treatment is life-saving for a LARGE percentage of treatment-resistant cases. Ketamine doesn’t work for everyone, but we’re learning every day how to help more people benefit from it’s restorative actions.
At Innovative Psychiatry, we work with people who suffer from PTSD and with people who suffer from suicidal thoughts. We’ve been so gratified to watch them walk out of the office with a smile, and energy, and a joy for living.
If you suffer from PTSD, depression, bipolar depression, social anxiety, addiction, or other disorders that make life seem hopeless, or if you have thoughts about ending your life, call us. Let’s work together to help you find your joy, your hope, your fulfillment, and your relationships again.
We want you to see how appealing life can be.
To the emerging of your best self,
Lori Calabrese, M.D.
*****If you or someone you know is contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255. There’s someone available to listen 24 hours every day.*****