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Troubled Teens (video)
August 23, 2002

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Interviewees: Sharon Azzato, Mother; John Mann, and David Shaffer, New York State Psychiatric Institute.

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Produced by Sanjanthi Velu

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Elsewhere on the web 

Teen Suicide from the National Alliance for the Mentally Ill 

National Mental Health Association teen suicide page 

Seratonin and Judgement - Society for Neuroscience

Are some teenagers at risk to attempt suicide because of the way their brains work?

And as this ScienCentral News video reports, researchers are examining special brain x-rays for clues.

Teens at risk

The National Household Survey on Drug Abuse (NHSDA) recently reported that 3 million youths in the U.S. had thought about suicide or attempted suicide in the year 2000. Only 36 percent of these youngsters who are at risk for suicide actually received mental health treatment or counseling.  

Dr. John Mann, chief of neuroscience at New York Psychiatric Institute (NYSPI) and professor of psychiatry and radiology at Columbia University, says this is mostly because they don’t realize they need help, and they don’t know that treatment is available.

But not all teenagers who are depressed or who think about suicide actually commit suicide. Mann says that the youngsters who are at risk seem to be more impulsive in general in their lives and act on powerful feelings and emotions. He says these kids feel "more depressed, more hopeless, more pessimistic, and they don’t think they’re going to get better. They don’t feel confident that the treatment is going to be helpful. And they are more likely to act on these more powerful feelings." 

Mann explained that the front of the brain above the eyes, called the prefrontal cortex, is "responsible for restraint or preventing...these kinds of impulsive decisions." A chemical messenger called serotonin mediates this decision-making function and acts as part of the brakes in decision-making.

Doctors have been able to study this function using positron emission tomography (PET) scans of the brain. They compared the brains of people who have committed suicide with the brains of those who have died from other causes, like in an accident, and found that people who commit suicide have less serotonin in their brains. "If you don’t have enough serotonin function you’re psychological decision making brakes don’t work, says Mann. "You’re more likely to act on feelings that you shouldn’t be acting on." 

Mann indicates that suicide also happens to be genetic. If a person’s parent or brother or sister has committed suicide, then the chances of that person committing suicide are increased. "We don’t know why exactly that is," says Mann. "We think it’s because you inherit a predisposition to become depressed or to get manic depression, which definitely runs in families."

Research has further revealed that slightly more girls than boys think about suicide and make suicide attempts. But about 5 times more boys than girls actually commit suicide. One reason for this is that "boys tend to be more aggressive, and a high proportion of youngsters who commit suicide have a history of being aggressive," according to Dr. David Shaffer, chief of child psychiatry at NYSPI and professor of child psychiatry at Columbia. He also says alcohol abuse and certain kinds of substance abuse are more common in boys than girls, and a combination of depression and alcohol is likely to end in suicide. 

Although suicide happens to be the third leading cause of death for young people 15-24 years old (behind unintentional injury and homicide), not all is gloom and doom. According to Shaffer the suicide rate among young people in the United States has fallen dramatically over the past 12 years. He thinks it could be because pediatricians and family practitioners are prescribing the newer kinds of anti-depressants, such as selective serotonin reuptake inhibiting (SSRI) drugs. These drugs seem to increase the amount of serotonin available in the brain.

While there are some kinds psychotherapy which may be effective at least in the short term for depression, Mann says there are not many therapists who are particularly well-trained in those kinds of treatments, and in general therapy takes several months. So Mann believes that anti-depressants form the most crucial part of mental health treatment but points out two limitations in current anti-depressants.

"The first", he says, "is they don’t work for everybody. So you have to try one anti-depressant, then another one, then another one. The second is that even if you have an anti-depressant that works for an individual, it takes weeks to work".

So he stresses the need for developing a way of choosing the anti-depressant that will work in that particular patient (this could be by using PET scanning techniques, brain imaging, genetic profiling, etc), and a need for anti-depressants that work in hours or days rather than weeks. But that will come about only through more research and drug development.

by Sanjanthi Velu

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