Several celebrity suicides and a recent Centers for Disease Control and Prevention report showing suicide rates increasing by 30 percent over the past 20 years (38 percent in S.C.) are enough to make anyone sad. Why are so many people deciding to end their lives this way? What can we possibly do?
While there are some people who choose suicide at the end of life because of illness, physical pain and suffering, the vast majority of people who attempt or complete a suicide suffer from depression, or addiction, or both. Unfortunately, many have not sought care or could not afford to. It's past time to destigmatize mental health disorders and improve access to care in our society. It should come as no surprise that the rise in opioid use and increase in suicides coincides with progressive cuts in funding over the past 20 years to mental health treatment centers across America and South Carolina. It's a multi-layered problem, with no easy fixes. So, again, what can we do?
When people think suicidal thoughts and are in crisis, their brain is not functioning correctly. Although they are not usually psychotic (imagining or seeing things) and they are fully oriented to who they are, their higher cognitive brain is not working. They truly do not see or value who they are, and they cannot imagine solutions to life problems. They see only one solution, death, and forget how important they are in the world. They don't realize the pain their death will leave behind, sometimes for generations.
Suicidal crisis is an abnormal brain state often arising out of a brain disease (depression or substance abuse or both). It is not moral weakness or mere sadness. Thus, we desperately need effective treatments to get people thinking rationally again. The good news is that we are developing these treatments at MUSC and other research universities around the world.
If a part of the brain that is supposed to help us see solutions and plan the future is not working when someone is in suicidal crisis, perhaps we could exercise or jumpstart that part of the brain and nudge people into wellness? In 2008, the FDA cleared a new device, transcranial magnetic stimulation (TMS), for treating depression in patients who have not responded to medications. Pioneered by a dedicated team at MUSC and myself, it typically takes several weeks to work. Three years ago at MUSC and the Ralph H. Johnson VA Medical Center, we delivered a condensed form of this treatment (only three days) to patients admitted to the hospital after attempting suicide. TMS cut suicidal thinking in half within 24 hours. More studies are ongoing using TMS in hospitals and even emergency rooms, and patients can access this treatment now.
Another, albeit older, form of brain stimulation, electroconvulsive therapy (ECT), remains the most effective treatment of suicidal thinking in patients with depression. More than 80 percent of patients treated with ECT have almost complete remission of their suicidal thinking and depression. However, ECT also causes some forms of memory loss. MUSC researchers have developed a new form of ECT that appears to be as effective as the older forms, without any measurable memory loss. With fewer side effects, more patients should be considering this option.
There is also research currently happening around an older medication used in anesthesia, called ketamine. If given in a lower dose than what's used to put people to sleep, ketamine has rapid (within a few hours) and effective reductions in suicidal thinking. While the effects may only last a few days, getting people safe and out of the crisis while starting other treatments can often bridge the gap to long-term safety and recovery. MUSC is currently sponsoring a clinical trial of an intranasal form of this compound.
Finally, a conversation on this topic is incomplete without mentioning the role that telehealth is playing in breaking down barriers for those who need access to psychiatric care. By offering therapies, counseling and access to cutting-edge treatments through the specialists at MUSC and other medical centers, clinicians all over the state are finding more convenient, effective and cost-conscious ways to get these important options accessible to those who need them most.
With other "epidemics" such as heart attacks or strokes, society had no real ability to change its response to those issues until we developed new treatments. Today, we have effective treatments and know the first warning signs of each, and our friends and family members largely know when and how to seek help for these diseases. We have this same opportunity to treat suicidality. We have effective treatments, and more are coming through continued research at MUSC and other institutions around the country. So, one last time, I ask, what can we do?
We must encourage friends and loved ones to get help. We, all of us, must share information with those in our lives who are suffering and support them in seeking treatments. Rather than getting sad, wringing our hands and giving up hope, we must treat suicidality as a symptom of brain disease, not a character flaw. And at MUSC, know that we are doubling down on finding new brain treatments for suicidal crisis and will work even harder to get these treatments clinically available.
Mark S. George, M.D., is a distinguished professor of psychiatry, radiology and neuroscience with the MUSC Department of Psychiatry and Behavioral Sciences and the Layton McCurdy endowed chair and director of the Brain Stimulation Laboratory.
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