Once we have picked apart the specific mechanism, this new understanding could eventually change the way we treat people with depression. Firstly, it could help identify who is most at risk for suicidal tendencies. 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. Preliminary explorations of the technique have been positive, but much larger trials will be needed before any form of this test could be used in the clinic.

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. Other drugs could have a similar function.



New options

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 – sometimes with long-lasting effects. 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. A better understanding of the brain changes involved – and the way it influences someone’s thinking – may even help refine the talking therapies by helping to identify the thought processes that are most severely disrupted as a consequence, says van Heeringen.

It is unlikely that any single treatment will ever be a panacea for people suffering from severe and suicidal depression. Instead, the strength of this new approach lies in the many different strands; where there was once a murky darkness, neuroscientists and psychiatrists are now beginning to see a kaleidoscope of new options. If they can be adapted to each patient’s specific circumstances, that might save an enormous number of lives from being needlessly taken from the world.

If you feel suicidal yourself, or know someone who might be, the advice is to seek medical help as soon as possible. The International Association for Suicide Prevention has a list of global agencies that may also be able to provide immediate support.

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