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We're a little crazy, about science!

Suicide, it might be in the blood

suicide-comp

I tried to kill myself, more than once in fact. It was a troubling time for me and as a former active duty Marine that might not be too surprising for people to hear. I’m not proud of it and with where I am now, it seems like a pretty solid decision to stay alive, honestly if it wasn’t for my brothers in arms I might not even be typing this now. Unfortunately the statistic for suicide in the military is high enough that no one would have been shocked. Typically the “treatment” is therapy and medications, I say “treatment” in parentheses because you would have to know something was wrong first. But what if suicide was more than just in your head? What if it was in your blood too?

Well now, John Hopkins researchers say they have discovered, a chemical alteration in a single human gene linked to stress reactions that, if confirmed in larger studies, could give doctors a simple blood test to reliably predict a person’s risk of attempting suicide. Potentially opening up the door to better prevention, treatments and even follow through.

The discovery,suggests that changes in a gene involved in the function of the brain’s response to stress hormones plays a significant role in turning what might otherwise be an unremarkable reaction to the strain of everyday life into suicidal thoughts and behaviors. It may also help explain why my fellow service members are dying, not on the battlefield, but here at home and away from the stress of battle.

“Suicide is a major preventable public health problem, but we have been stymied in our prevention efforts because we have no consistent way to predict those who are at increased risk of killing themselves,” says study leader Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences. “With a test like ours, we may be able to stem suicide rates by identifying those people and intervening early enough to head off a catastrophe.”

For the series of experiments, researchers focused on a genetic mutation in a gene known as SKA2. They tested this hypothesis by looking at brain samples from mentally ill and healthy people, the researchers found that in samples from people who had died by suicide, levels of SKA2 were significantly reduced.

Within this [common] mutation, they then found in some subjects an epigenetic modification [epigenetic changes alter the way a gene functions without changing the gene’s actual DNA sequence. Think of it like a musician, who may play a piece of music differently without changing the notes]. The modification added chemicals called methyl groups to the gene. Because of this higher levels of methylation were then found in the same study subjects who had killed themselves.

That isn’t the only thing the researchers found, the team then tested three different sets of blood samples, the largest one involving 325 participants in the Johns Hopkins Center for Prevention Research Study, what they found was the similar methylation increases at SKA2 in individuals with suicidal thoughts or attempts.

They followed this finding by designing a model analysis that predicted which of the participants were experiencing suicidal thoughts or had attempted suicide with an amazing 80 percent certainty. Those with more severe risk of suicide were predicted with 90 percent accuracy. In the youngest data set, they were able to identify with 96 percent accuracy whether or not a participant had attempted suicide, based on blood test results alone. Which in my opinion is a huge deal.

So about this SKA2 gene, this gene is expressed in the prefrontal cortex of the brain. This area is involved in inhibiting negative thoughts and controlling impulsive behaviors. SKA2 is basically responsible for chaperoning stress hormone receptors into cells’ nuclei so they can do their job. If there isn’t enough SKA2, or it is altered in some way, the stress hormone receptor is unable to suppress the release of cortisol throughout the brain. This finding supports previous research that has shown that such cortisol release is abnormal in people who attempt or die by suicide.

A test based on these findings might best be used to predict future suicide attempts in those who are ill, to restrict lethal means or methods among those a risk, or to make decisions regarding the intensity of intervention approaches.

If further studies show as much promise, this type of blood test could help servicemembers coming home without the stigma of having to ask for help.  Those at risk could be more closely monitored when they returned home after deployment or even have treatment tailored to them. A test could also be useful in a psychiatric emergency room, as part of a suicide risk assessment when doctors try to assess level of suicide risk.

The test could be used in all sorts of safety assessment decisions like the need for hospitalization and closeness of monitoring. Another possible use that needs more study could be to inform treatment decisions, such as whether or not to give certain medications that have been linked with suicidal thoughts such as certain types of antidepressants.

“We have found a gene that we think could be really important for consistently identifying a range of behaviors from suicidal thoughts to attempts to completions,” Kaminsky says. “We need to study this in a larger sample but we believe that we might be able to monitor the blood to identify those at risk of suicide.”

Sometimes it’s sad to wake up in the world where it is frowned upon to talk about mental illness. You go to the doctor when you break a bone. You take medicine and take it easy when you have the flu or cold. But you suck it up and just “be happy” when you are suffering from depression. It’s just as real as a broken bone and just like a broken bone. If you don’t get help it will never heal right.

one a day

Want to read more? You can find the full study —here!

Sources
Guintivano, J., Brown, T., Newcomer, A., Jones, M., Cox, O., Maher, B., Eaton, W., Payne, J., Wilcox, H., & Kaminsky, Z. (2014). Identification and Replication of a Combined Epigenetic and Genetic Biomarker Predicting Suicide and Suicidal Behaviors American Journal of Psychiatry DOI: 10.1176/appi.ajp.2014.14010008

Guintivano, J., Arad, M., Gould, T., Payne, J., & Kaminsky, Z. (2013). Antenatal prediction of postpartum depression with blood DNA methylation biomarkers Molecular Psychiatry, 19 (5), 560-567 DOI: 10.1038/mp.2013.62

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