New drug treatment may rapidly reduce suicidal thoughts
By Kevin McKeough
Every 13 minutes of every day, on average, someone in the U.S. commits suicide. Many of those deaths are preventable.
“Depression is not normal. Effective medication and therapies are available to return people to normal psychological function and reduce their risk of suicide,” says Mark Pollack, MD, Grainger professor and chairperson of the Rush Department of Psychiatry. Pollack also is president of the Anxiety and Depression Association of America.
“This is a treatable illness. People shouldn’t have the false assumption that they have to live their life like this,” adds John Zajecka, MD, clinical director of the Woman’s Board Depression Treatment and Research Center at Rush. He is helping lead a national study of a new form of treatment to see if it can reduce depression symptoms, including suicidal ideation, quickly.
Yet suicide rates remain tragically persistent. “Despite all the treatments we have today, suicide rates have increased. You would think we’d see a reduction,” says Zajecka, who is a member of the scientific advisory board of the American Foundation for Suicide Prevention.
The suicide rate nationwide has been increasing gradually since 2000, with 41,149 suicides taking place in the U.S. in 2013 (the most recent year for which data is available), according to the U.S. Centers for Disease Control and Prevention.
That trend adds greater urgency to the annual observance of September as Suicide Prevention Awareness Month, especially since suicide’s toll can’t be measured in deaths alone. The CDC reports that an estimated 1.3 million attempted suicide in 2013 and about 9.3 million adults had suicidal thoughts during that period.
The danger is even greater for high school-aged children: In 2013, 8 percent of students in grades nine to 12 attempted suicide and 17 percent seriously considered doing it, according to the CDC.
Calls for more screening and access to care
Adolescents’ high risk of suicide is part of the reason why on Sept. 8, the U.S. Preventive Services Task Force issued a draft recommendation that children ages 12 to 18 be screened for major depressive disorder.
Pollack believes that better screening for suicidal thoughts among patients at all ages could help prevent suicides, noting that most people who kill themselves had interactions with some kind of medical professional in the months immediately before the suicide.
“There’s been a reluctance in medical and other settings to ask about suicides and risk factors like depression,” he says. There is a mistaken notion that asking an individual about suicide will ‘put the idea in their heads.’
“In fact, patients are often relieved to be able to talk about these distressing thoughts. Screening for suicidality can be a life-saving intervention.”
He also points out that barriers to access to mental health care remain, despite the passage of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act of 2008, which required that insurers’ mental health coverage be comparable to other medical coverage.
About one-third of people the U.S. find mental health care inaccessible, and more than four in 10 see cost as a barrier to treatment, according to a study released at the beginning of September by the ADAA, AFSP and the National Action Alliance for Suicide Prevention.
“We need to make sure people with mental health issues have ready access to care,” Pollack says.
Risk factors, warning signs and what to do
Access to mental health services is critical, given that more than 90 percent of people who commit suicide are suffering from at least one psychiatric disorder such as depression, bipolar disorder, anxiety disorder and abuse of alcohol and/or other drugs, according to the AFSP.
External stresses, such as job loss, financial strains, divorce or bullying, add to the risk of suicide. “Environmental stressors like these in association with an underlying psychiatric disorder can be a particularly lethal combination,” Pollack says.
Military veterans are particularly at risk, with 22 killing themselves on average each day, adds Pollack, who is director of the Road Home Program at the Center for Veterans and Their Families at Rush. “More veterans have died by suicide in the last decade than by military combat,” he observes.
People who have attempted suicide in the past are at greater risk to do it in the future. Individuals who have contemplated particular means for killing themselves — including those with ready access to firearms or those who have stockpiled pills — are at particular risk.
Further, those who talk about life not being worth living, being a burden. wishing they were dead. or plans to harm themselves are in danger of harming themselves. According to the AFSP, somewhere between 50 and 75 percent of people who commit suicide give warnings to someone beforehand.
“There’s a misconception that people who do it, don’t talk about it,” Pollack says. “Actually, the opposite is often true. A lot of people show up in medical offices in the weeks and months before they attempt to kill themselves, suggesting there are opportunities to intervene.”
If someone is expressing suicidal thoughts and feelings, refer the person for help immediately. “If somebody is actively suicidal and talking about killing themselves, it’s a medical emergency that required urgent intervention,” Pollack says. “I would get them into an acute setting — an emergency room or a medical or mental health provider’s office immediately,” he continues. “
A potential quick way back from the brink
Rush investigators are working to develop novel interventions that may provide rapidly acting, effective treatment for individuals at the brink of killing themselves. Zajecka is studying the use of esketamine (a formulation of the anesthetic ketamine) to treat depression and significant suicidal thoughts in people who either seek help in an emergency room, are referred for hospitalization by a health care provider or are self-referred.
Studies show that ketamine has rapid antidepressant effects when it’s administered intravenously, but the time and effort needed for IV medications makes that method impractical for treating suicidal episodes. Instead, the study will evaluate eskatamine delivered in a nasal spray.
Rush is one of a dozen academic medical centers nationwide participating in the study, which is sponsored by Janssen Pharmaceuticals., Inc.
Half the patients in the study will receive eskatamine in four-day intervals, beginning with their hospitalization, and the other half will receive a placebo. (Both groups also will receive standard antidepression treatment.)
All the patients will undergo a psychiatric assessment an hour after receiving the drug or placebo to evaluate the degree of their suicidal feelings. The researchers will compare the results of the evaluations to see if the group receiving eskatamine shows greater improvement than the placebo group.
“One of the most important things we can do as doctors is provide hope and let people know there are treatments out there and never give up,” Zajecka says. “Hope is so important in this.”
For more information about the study, or to self-enroll, call the confidential voice mail number for the Woman’s Board Depression Research and Treatment Center, (312) 942-6597.