Neurobiological Basis of Suicide Risk : Polish Review Includes ECT

 Out on PubMed, from investigators in Poland, is this study:

Neurobiological Basis of Increased Risk for Suicidal Behaviour.

Wisłowska-Stanek A, Kołosowska K, Maciejak P.Cells. 2021 Sep 23;10(10):2519. doi: 10.3390/cells10102519.PMID: 34685499
The abstract is copied below:
According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus-pituitary-adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.
Keywords: BDNF; clozapine; cortisol; epigenetics; esketamine; ketamine; kynurenine pathway; lithium; serotonin; suicide.
The pdf is here.
And from the text:

This is an excellent, comprehensive review of the neurobiology of suicide. Here again, we see the primacy of the inflammation hypothesis of depression.
The ECT discussion is tiny and idiosyncratically referenced, with 2/5 of the ECT references about ECT in pregnancy.
While it is good to see ECT mentioned, I wonder what it will take to get ECT better noticed as an important treatment for acute suicidality in mood and psychotic disorders?
For anyone interested in the neurobiology of suicidal behavior, I recommend a full read, ~25 minutes.



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