Abstract

GUTIERREZ-GARCIA, Ana G.  and  CONTRERAS, Carlos M.. Suicide and some neurobiologic correlates. First part. Salud Ment [online]. 2008, vol.31, n.4, pp.321-330. ISSN 0185-3325.

Suicidal behavior is a complex and multifactorial phenomenon. At present, growing evidence shows the participation of biological traits in suicidality. Some findings suggest the dysfunction of the serotonin system, since serotonin and some of its receptor subtypes are involved in the modulation of such as affective behavior and cognition, among other behavioral processes. The content of 5-hydroxyindoleacetic acid, the major serotonin metabolite, is reduced in the cerebrospinal fluid of violent suicide attempters, independently of any other previous psychiatric diagnosis. In fact, this reduction may predict future suicide attempts and suicide completion. Post-mortem studies of ventromedial prefrontal cortex from suicide victims show decreased density of the 5-HT_1A presynaptic serotonergic receptor subtype, and a compensatory upregulation of the 5-HT_2A serotonergic post-synaptic receptor subtype. These observations on suicide strongly suggest a role of the two serotonin receptor subtypes located in this cortical brain region. Dysfunction of this region may support the diathesis concept (vulnerability) associated to suicidal behavior. In fact, some people display impulsive and self-aggressive behavior as part of their suicidality. This dysfunction is associated with alterations in the polymorphisms of tryptophan hydroxylase gene expression, i.e., the rate-limiting enzyme which in turn modifies the biosynthesis of serotonin, contributing to the reduction of serotonergic activity. Since the prefrontal cortex and related structures play a major role in mood regulation, their participation in the pathophysiology of affective disorders and suicide is currently being discussed. A circuit integrated by prefrontal cortex, hippocampus, amygdaloid complex, lateral septal nucleus and other functionally related structures could be involved in the regulation of emotional memory, hedonism and decision-taking. The hippocampus is implicated in cognition and is one of the cerebral structures strongly affected by stress. Structural abnormalities in cortical and hippocampal areas and reduced hippocampal plasticity have been demonstrated in patients suffering from chronic stress and affective disorders. Reduced neurotrophin expression may be associated with structural abnormalities and reduced hippocampal plasticity. A decrease in the content of neurotrophins in the prefrontal cortex and hippocampus could be of relevance in suicidal behavior. Human post-mortem studies supported by living animals studies have demonstrated that antidepressants increase the activity of the brain-derived neurotrophic factor (BDNF) and increase the density of its receptor (BDNF-tyrosine kinase receptor B: trkB), which seems to participate in the therapeutic effects of drugs used in the treatment of depression. On the contrary, the reduction of BNDF trkB-receptor mRNA has been related to suicidal behavior, since a reduction of plasma BNDF levels has been reported in major depression. BNDF levels have also been suggested as a biological marker of suicidal depression. Abnormalities in the ventromedial prefrontal cortex in suicidal individuals largely correlate with the neurochemical deficits reported in this population. In fact, prefrontal hypofunction and impaired serotonergic responsivity are proportional to the lethality of the suicide attempt. Positron emission tomographic studies indicate lower ventromedial prefrontal cortex activity, behaviorally associated with high impulsivity, higher planning of suicidal intent, and higher-lethality suicide attempts. Other studies have also related structural abnormalities in amygdala with suicidality. The function of this region is critical regarding fear, anxiety, aggression and the recognition and response to danger, i.e., some behavioral patterns involved in suicidality. Anxiety commonly follows or precedes depression. Therefore, amygdaline dysfunction may increase the risk of suicidal behavior. For depressive-suicide attempters, the suicide act itself occurs at a moment of extreme anxiety, strongly suggesting amygdaloid complex participation in the process. Lastly, the lateral septal nucleus is related with anhedonia and hopelessness (despair). Since its neuronal firing rate increases after the experimental application of clinically effective antidepressant treatments. The septal nucleus is considered a target of these drugs, a suggestion supported by the observation that anhedonia is one of the main symptoms in depression and lateral septal nucleus activity is involved in hedonic process. Anhedonia, hopelessness and other depressive symptoms are significantly related to suicidal ideation. Taking into account that some patients with major depression are vulnerable to suicide, this vulnerability may result from the interaction of suicidality with environmental precipitants and a lowered threshold for suicidal behavior. Certainly, one of the psychiatric disorders associated with suicide is depression, which suggests a causal relationship and suggests the involvement of these brain structures in suicidality.

Keywords : Antidepressant; depression; suicidality; serotonin; suicidal ideation.

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