I’m Thinking About Suicide

Ever thought about suicide?

Many have.

And not all of them are depressed.

Some are epidemiologists – folks whose business it is to think about the source, causes, and prevention of disease. And then, other health professionals such as physicians, Nurses, psychologists, social workers, and others think about suicide – again, not as means to end their own lives, but for the sake of others. And yet Nurses and physicians also personally think about suicide, and often at rates greater than the average population.

I’ve thought about suicide.

I’ve thought about suicide many times.

In fact, I’m thinking about suicide as I write this entry.

But I’m not thinking about suicide as a means to end my own life.

I’m thinking about suicide because…

Another friend recently ended his own life.

Another friend.

Another.

Friend.

In fact, suicide has touched my life more times than I care to think about. More about that later.

Suicide is more prevalent than many imagine.

According to the World Health Organization, nearly 800,000 people die from suicide annually worldwide, which is about one person every 40 seconds. There are many more suicide attempts than suicides, and globally, suicide is the second leading cause of death among those aged 15-29.

Suicide is a global phenomenon, and occurs in wealthy nations, as well as in poverty-stricken nations. And while it typically affects men at a greater rate than women, it is not a respecter of persons. Global regional average suicide rates per 100,000 range from 3.9 in the Eastern Mediterranean, to 7.4 for Africa, are 9.8 in the Americas, 10.2 in the Western Pacific, 13.2 in South-East Asia, and 15.4 in Europe. The average suicide rate globally is 10.6 per 100,000.

You might be shocked to learn that suicide rates in the Russian Federation and Lithuania are the highest globally at 31 and 31.9 per 100,000, respectively. The lowest average suicide rate globally is in Antigua and Barbuda at 0.5 per 100,000.

While suicide accounts for about 1.4% of all deaths every year, part of the reason – perhaps THE GREATEST, or even solitary reason – why suicide is such a significant health concern is because it’s 100% preventable. People die of cancer, even though they didn’t smoke, work or live around carcinogens, didn’t have a family history of cancer, “ate right,” exercised, and did everything they were “supposed” to, and could do, to prevent it. Same thing with heart and cardiovascular disease. Not so with suicide. People make a conscious decision to end their life.

In the United States, suicide rates have been mostly unchanged since 1950.

For 66 years – from 1950 to 2016 – the suicide death rate for males has been consistently and significantly higher than that of females. And while it has fluctuated only very slightly, the U.S. suicide death rate for males and females since 1950 remains virtually unchanged. In 1950, the overall American suicide rate per 100,000 residents was 13.2, and in 2016 it was 13.5.

In the United States, Montana had the highest suicide rate in 2016 with 26 suicides per 100,000 residents, followed by Alaska with 25.4, and Wyoming with 25.2. And in 2016, individuals aged 45 to 64 were the age group most likely to die by suicide with a rate of 19.2 per 100,000 in 2016. Those aged 65 or older were only slightly less affected, with a 16.7 per 100,000 rate. Equally alarming was the almost identical suicide rate of those aged 25-44 years, which was 16.9 per 100,000.

All these facts and figures are like dancing about architecture. We’re only talking about the problem using numbers – prevalence, location, age and sex – they are statistics about a statistic. It doesn’t tell us anything – not even one thing – about why. That is what we’re missing, and that is what needs to be discussed EVEN MORE.

People ask “WHY?!?” about those who commit suicide. And for the greatest part, the answer to that question is because of immense, overwhelming feelings of hopelessness and helplessness – a sense of being powerless to change one’s life, or the circumstances in it, and the suffering that inevitably accompanies it.

While suicide is often found with depression, it’s not always a byproduct of it. In fact, only 5-10% of people with depression seriously attempt suicide, and 20-30% of those who commit suicide have no history of depression. Simply put, not all depressed people commit suicide, and not all who commit suicide are depressed – but they are often found together.

Ironically, some anti-depressant medications increase the risk of suicide, which is a most unfortunate and tragic finding. However, one bright light upon the horizon for the treatment of suicide and depression is the discovery that the anesthetic medication ketamine has clinically proven efficacy (medical speak for “IT WORKS!”) in the amelioration, rapid, and often complete elimination of suicidal ideations (thoughts).

It was in Birmingham, Alabama, in 2012, at the University of Alabama at Birmingham Hospital (UAB) that physician/researchers found that ketamine was useful in stopping suicide and suicidal thoughts in extremely depressed people. Ketamine has been in use since the 1970’s as an anesthetic. When a medication is found to have a secondary use to treat another disease or symptom for which it was not originally made, it’s called an “off-label” use of the medication.

How does ketamine work to help stop suicidal thoughts and depression?

Ketamine works differently – and importantly, much more quickly – than many common antidepressant medications like Prozac, Zoloft, and Effexor, which may also explain why people who aren’t helped by standard treatments respond to ketamine when other medications don’t help.

Dr. Richard Shelton, MD, a Professor in the Department of Psychiatry and Behavioral Neurobiology and lead investigator in one of the ketamine studies done at UAB in 2013, said that ketamine appears to work on depression by blocking a neurotransmitter called glutamate from binding to the NMDA (glutamate) receptor on neurons. Too much glutamate on an NMDA receptor leads to the opening of a calcium ion channel, releasing too much calcium downstream. That then affects a brain chemical called Brain Derived Neurotrophic Factor (BDNF) which increases connections between neurons in the brain. Those connections help the brain to better regulate emotions.

In the study, patients who came to the Emergency Department (ED) with suicidal thoughts were enrolled in the ketamine research. The medication was administered via intravenous infusion, which took about five minutes.

Dr. Cheryl McCullumsmith, MD, PhD, Assistant Professor and Director of Hospital Psychiatry, said that, “We have seen a decrease in depression scores and suicide scores, sometimes within 15 minutes after giving ketamine. The antidepressants commonly used to treat depression and suicidal thoughts take weeks or months to begin to show positive effects. When a patient is actively suicidal, we don’t have that much time.”

She also said patients who entered the ketamine study at the ED were also admitted to the psychiatric inpatient unit for observation.

Dr. Elizabeth Ballard, PhD, a researcher at the National Institute of Mental Health, published a study that found ketamine reduced suicidal thoughts separately from its effect on depression or anxiety. That’s an important discovery because not all suicides can be traced back to depression. Post-Traumatic Stress Disorder (PTSD), borderline personality disorder, and alcohol or other substance dependence also account for some suicides.

Since the 2013 UAB study, ketamine has been used increasingly throughout the U.S. to help those who are actively considering suicide. It’s also being used in smaller, private clinics to help treat depression. However, the Food and Drug Administration (FDA) hasn’t yet given their official “seal of approval” to ketamine for use as an antidepressant, even though it’s actively and successfully being used for that off-label use.

The FDA writes this about off-label use of medications: “It is important to know that before a drug can be approved, a company must submit clinical data and other information to FDA for review. The company must show that the drug is safe and effective for its intended uses. “Safe” does not mean that the drug has no side effects. Instead, it means the FDA has determined the benefits of using the drug for a particular use outweigh the potential risks.”

So because ketamine is not FDA-approved for use in depression, insurance companies won’t pay for it, and treatment costs must come “out-of-pocket.” As well, because ketamine is an anesthetic, many clinics throughout the nation are staffed by anesthesiologists, instead of psychiatrists.

Treatment initially consists of six infusions over 12 days which costs $3,800, with each infusion lasting about 45 minutes. Side effects often include confusion, lucid daydreaming, and fuzzy vision, but but go away as soon as the infusion is over, and patients don’t have hallucinations.

Patients are also watched very closely and must have pre-arranged transportion home, and are barred from driving or using heavy machinery for 24 hours afterward.

Ketamine’s beneficial effects last anywhere from 3 to 5 weeks for some patients, and up to 12 weeks for others. Patients return as needed for single boosters, which cost $600. About 75% of patients aged 15-55 are helped by ketamine. Older patients have a lower response rate. Its long-term effectiveness is unknown.

Again, because the FDA has not approved ketamine for use to treat depression, insurance won’t pay for it.

Ketamine in the form of a nasal spray delivery method has also been found effective.

It should be understood, however, that while ketamine works rapidly to eliminate suicidal thoughts, it isn’t a “miracle drug.” Other treatments must accompany use of that medication, including talk therapy, and sometimes, includes changes to one’s lifestyle.

Fortunately, we’re in a better place today than we were 20 years ago. Many of the younger generation are more supportive of each other and more willing to help or discuss those things than previous generations were.

When we get universal healthcare that covers mental health and remove the career-ending stigma of depression and mental health, things will be significantly improved. Until that time, we must work like hell to pass laws to save our lives.

Now… about how suicide has touched my life more times than I care to think about.

Just yesterday, I learned that a high school classmate recently took his life. He had been an English teacher in Saudi Arabia for many years, and was gay. (That’s not a good combination.) He’d been working in “the kingdom” for quite some time, and last we communicated a few months ago, he directly expressed to me his immense dissatisfaction with the way things had been going for him with his employer, his working and living conditions, and was hoping he could come home soon to stay. He’d even thought about raising hogs once home. His dear mother is still living. If you’re the praying type, please remember her – and others whom loved him – in your prayers.

• My maternal Grandfather committed suicide while my mother was in the early stages of her pregnancy with me. She and my father had not yet told anyone of her pregnancy.

• While in high school, a friend a couple years younger than me committed suicide after he learned that his girlfriend was pregnant.

• After high school, I learned that an underclassman had committed suicide in the bathroom during a party at his house.

• After university, I was told that another high school classmate had committed suicide in the backseat of his father’s car.

• A good friend and high school classmate had earlier taken his life while in a jail cell for public intoxication after he’d recently left the Navy.

• A few more years later, I learned that a beautiful underclassman friend and neighbor with whom I had been smitten for years, had ended her life.

• And as a Nursing Professional, I learned that an ICU colleague had taken her life. We all were stunned.

I could share a few more stories about those whom I’ve directly known, or close others whom have committed suicide, but I’ll spare you.

This.

Must.

Stop.

You can help.

Here’s how:

5 Action Steps for Helping Someone in Emotional Pain

• Ask: “Are you thinking about killing yourself?” It’s not an easy question but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
• Keep them safe: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the person has a plan and removing or disabling the lethal means can make a difference.
• Be there: Listen carefully and learn what the individual is thinking and feeling. Findings suggest acknowledging and talking about suicide may in fact reduce rather than increase suicidal thoughts.
• Help them connect: Save the National Suicide Prevention Lifeline’s number in your phone so it’s there if you need it: 1-800-273-TALK (8255). You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
• Stay Connected: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

https://www.nimh.nih.gov/news/science-news/2018/suicide-how-you-can-make-a-difference.shtml