Understanding Suicide Risk in Bipolar Teens

A new study of adolescents and young adults suffering from bipolar disorder and at high risk of taking their own lives found specific differences in the brains of those who attempt suicide and those who don’t.
“Suicide is a leading cause of death of adolescents and young adults, and we can’t move on this issue fast enough,” said Hilary Blumberg, professor of psychiatric neuroscience and professor of psychiatry, radiology and biomedical imaging at Yale University. “The identification of brain circuits involved in risk for suicide can lead to new ways to identify who is most at risk and hopefully, prevent suicides.”
About 50 percent of people with bipolar disorder, marked by extreme mood swings, attempt suicide during their lifetimes; as many as one in five of those with the disorder may die by suicide. In studies of adults who made attempted suicide, evidence points to problems in the frontal-limbic system, where emotions and impulses arise, and the frontal cortex, which helps regulate emotions and impulses.
For the study researchers studied adolescents and young adults. Since their frontal-limbic system is still developing, studying this age group could provide insight into how suicidal thoughts and behaviors start.
Specialized MRI scans of those who had attempted suicide and those who had not showed several striking differences. Those who had attempted suicide had subtle decreases in the volume and activity in areas of the brain circuitry that regulate emotion and impulses, and in the white matter, the wiring that provides connections between those brain areas.
“The findings suggest that the frontal cortex is not working as well as it should to regulate the circuitry,” Blumberg said. “That can lead to more extreme emotional pain, difficulties in generating alternate solutions to suicide, and greater likelihood of acting on suicidal impulses.”
Further research into brain circuitry developmental processes that lead to suicide can help identify individuals at increased suicide risk. The findings may help clinicians develop new strategies to minimize risk factors and fine tune therapies designed to strengthen the vulnerable brain circuits.