If you’ve ever felt alone in experiencing suicidal ideation, please know you’re not. According to the Centers for Disease Control and Prevention, 12.2 million adults have seriously considered suicide, and the numbers rose in 2021 from 2020. It’s immeasurably hard to think about.
After the news comes out about celebrities dying by suicide, you may have seen friends post the suicide hotline on Facebook. In the wake of Stephen “tWitch” Boss’ suicide in December 2022, hypnotherapist Keeylee Miracle wrote an important Twitter thread about an aspect of suicidal ideation our society doesn’t talk about as much: the hormonal and neuroscientific perspective. “It’s like a hostile brain takeover,” she wrote, urging people to take proactive measures (which we’ll get to in a bit).
Other than serving as a reminder about how intricate suicidality actually is, this understanding helps us do two main things: empathize with people without judging them, and support them (and ourselves) preemptively and effectively. But what exactly does all of that look like?
“There is no one common pathway to a suicide attempt,” said Dr. Laura Erickson-Schroth, chief medical officer at The Jed Foundation. “We often look to construct narratives about why someone attempts suicide — such as a job loss or relationship ending — but the truth is that most people who attempt suicide do not have one ‘reason’ but instead have multiple life events leading to the attempt.” She added the person may even experience ambivalence, having thoughts about wanting to die and wanting to live.
As cheesy as it may sound, knowledge is power here. “Understanding suicidality is like any other subject for mental health: The more we educate ourselves, the better the treatment we are able to offer the client,” said James Atkison, a licensed professional counselor with Thriveworks in Lubbock, Texas, who specializes in trauma, PTSD, suicidal and non-suicidal self-injury, depression and anxiety.
Keeping that in mind, let’s talk about the physiological side of suicide that isn’t brought in as much. Below, experts share what’s really going on in the brain. (The key takeaway here: Take people seriously if they’re thinking about or are actively harming themselves.)
Hormone Sensitivity In The Brain
Thoughts of suicide have been associated with major hormonal fluctuations and changes in the brain.
“Many clinicians and doctors see this as a cry for attention when there is mounting evidence that it is more likely the result of neurobiological hormone sensitivity, as seen in those diagnosed with premenstrual dysphoric disorder (PMDD), that may drive suicide risk and self-injurious thoughts and behaviors in those assigned female at birth,” Atkinson said.
He added that when these individuals discuss their mood-related concerns with providers related to their period, some providers dismiss them because of the stigma, which can become dangerous.
As you may already know, serotonin is a neurotransmitter that sends messages between your brain and body. It influences your mood, sleep, memory, sexual desire and more. So, when you’re feeling sad, your serotonin levels may be low or messed up.
This phenomenon can actually be seen in patients who have died by suicide. “Biological studies in postmortem patients who committed suicide are very limited, but have given some insights into the neurobiology of what causes suicidal ideation,” said Dr. Julian Lagoy, a psychiatrist in San Jose, California. “Research points to serotonergic abnormalities, which contributes to impulsive and aggressive behavior that leads to a suicidal attempt.”
Activation Of Brain Circuits
While no one brain pathway is responsible for controlling suicidal thoughts, several brain circuits are at play, according to Erickson-Schroth.
“There has been increasing research in recent years into the neuroscience of suicidal thoughts and attempts, with studies demonstrating the involvement of multiple brain circuits having to do with future thinking, decision-making, emotion regulation and impulsivity,” she said.
Mental And Physical Fatigue
While research is limited, ties between brain chemistry and symptoms/causes of suicidal ideation are everywhere, anecdotally.
“What we do know is that when people are in a suicidal crisis, they often have a reduced ability to think creatively or engage in problem-solving, and may also have some distorted thinking, such as believing that no one cares or that they are a burden to others,” said Doreen Marshall, vice president of mission engagement at the American Foundation for Suicide Prevention. “They may also be having difficulty sleeping or sleeping too much, and notice changes in their appetite and energy levels, all of which can be connected to changes in the brain.”
Short-Term Thinking And Lower Impulse Control
Suicidal ideation and tunnel vision are closely linked, too. Marshall said individuals considering suicide often can’t see any other answer to resolving their pain. Lagoy added that the neurochemical changes can lessen impulse control, which is what leads to tunnel vision.
To further understand this, Atkinson recommended reading “Rethinking Suicide” by Dr. Craig Bryan, saying it’s a “great resource that helps us see that suicide is the last option for clients when they feel overwhelmed by life and can see no other options that will help them.”
How This Knowledge Helps Us All
While it’s important for us as a society to validate mental health as much as physical health, seeing how mental health is also physical can help people understand it and take it more seriously.
“When someone experiences a suicide crisis, their brain is not functioning in an optimal way, and it may be difficult for them to alleviate the pain that they are in,” Marshall explained. So just as you wouldn’t lecture someone who’s in an acute health crisis, she added, avoid doing that during acute mental health crises, too.
On that note, it’s important to remember that just because a situation doesn’t seem overwhelming to you doesn’t mean it’s not real for someone else. “Stress, for example, can impact our biology and hormone levels, as well as our mental health, but not all of us will experience stressors in the same way,” Marshall added. “Our brains respond differently when we are under stress, and our brains are unique in their biology and how they respond to stress.”
This info also brings awareness to how complex and difficult suicidality is. “We can use this knowledge to help us not blame or judge anyone who has suicidal ideation, and therefore be able to empathize with and help them more effectively,” Lagoy said.
How You Can Help Yourself
Seeing providers who understand this can be crucial. “As mental health providers, we can advocate for clients who vocalize these complaints,” Atkison said. “It is not unheard of for a counselor or social worker to call the doctor’s office, with the client in the room, to help advocate for our client to be heard.”
Erickson-Schroth mentioned certain types of therapy that can prevent suicidal thoughts from turning into attempts. Dialectical behavior therapy (DBT) and cognitive behavioral therapy for suicide prevention (CBT-SP) are a couple she said are underutilized.
The importance of being proactive with your mental health can’t be understated either, according to Marshall. She listed some helpful tips, such as getting treatment, sleeping enough, spending time outdoors, exercising, surrounding yourself with supportive people, practicing coping skills and more.
Medication is another important part — especially serotonergic medication, such as Prozac, Zoloft, Lexapro and Paxil, according to Lagoy. And again, don’t wait until you’re feeling suicidal. Talk to a doctor about starting a pill ASAP, if needed. (GoodRx coupons are an example of pharmaceutical coupons that can help financially.)
“Taking the time to have a real conversation about mental health with those around us, as well as modeling taking care of our own mental health, can make a difference for someone who is struggling in silence.”
How You Can Prevent Suicide In Other People
While suicide prevention is paramount (and not discussed enough), it’s also not something that’s entirely in your hands alone.
“We should never blame ourselves if someone we love dies by suicide,” Erickson-Schroth said. While interventions can help, it can be hard to predict who’s most at risk and when they’re most at risk, she added.
When you feel concerned about a loved one, reach out and offer support. Erickson-Schroth said this is the most important step. “It’s OK to say ‘suicide,’” she said. “It’s a myth that bringing up suicide will give someone ideas. Research shows just the opposite, that talking about suicide provides a sense of relief and increases the chances that someone will reach out for help.”
If the loved one doesn’t seem to want your help, The Jed Foundation advised continuing to reach out, spending time doing fun things with the person and bringing in a professional. If the person is a kid, especially, she encouraged teaching them emotion regulation skills, such as taking deep breaths, practicing self-compassion and cultivating positive experiences, early on.
Given the numbers, it’s likely you know someone who has considered suicide (whether you know about it or not). And all of us play important roles in preventing suicide.
“Taking the time to have a real conversation about mental health with those around us, as well as modeling taking care of our own mental health, can make a difference for someone who is struggling in silence,” Marshall said. For resources on how to have this difficult conversation, Marshall pointed to afsp.org.
Community care is an important part of the conversation, too. Erickson-Schroth said debt can increase the risk of suicide, and livable minimum wages can decrease the risk. While you may not be able to do much here, if you’re not an employer, you can donate to mutual aid funds and loved ones who need it.
If you don’t have money to share, that’s OK, too: Another way to help is by connecting with others in your community through volunteering, workshops, support groups, etc. She mentioned the powerful benefits of connection when it comes to people’s sense of belonging and worth.
Policy-wise, you can advocate for safe gun storage. “Because many suicide attempts are impulsive, means reduction has been shown to decrease suicide rates by limiting access to lethal means,” Erickson-Schroth said. “States with laws that require safe gun storage have lower suicide rates, and programs that encourage those with firearms to give them to a friend or family member while they are experiencing difficult emotions can save lives.”
For clinicians, Atkison recommended the Collaborative Assessment and Management of Suicidality. “It is a way of talking about and responding to those with suicidal ideation that make the conversation easier for all involved, as well as providing excellent documentation for the decision to hospitalize or not, and it does not always mean you have to send the client to the hospital,” he said.
Lastly, Erickson-Schroth shared some hope: “90% of those who survive a serious suicide attempt do not go on to die by suicide later,” she said. “Most find the help they need to be more actively engaged in life and connected with their communities.”
Ultimately, this scientific understanding will hopefully lead to more empathy and suicide prevention efforts.
If you or someone you know needs help, dial 988 or call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also get support via text by visiting suicidepreventionlifeline.org/chat. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.