Suicide, Serotonin, and the Brain
Abstract
Summary: The involvement of impaired serotonergic functioning in the development of suicidal behavior is one of the best documented findings in biological psychiatry. It is, however, less clear in which way this dysfunction contributes to the occurrence of suicidal behavior. Correlational studies have demonstrated associations between peripheral measures of serotonergic function and characteristics such as impulsivity, disinhibition, anxiety, and/or behavioral inhibition. Postmortem and neuroimaging studies have provided insight in the localization of serotonergic dysfunction in the central nervous system. Nevertheless, results in this area of research have also been contradictory. Following a short overview of recent research findings on serotonin and suicidal behavior, this paper focuses on the involvement of the prefrontal cortex of the brain in the development of suicidal behavior and on the role of serotonin in its executive functions. Based on these considerations, suggestions for future research are discussed.
References
(1996). Is there a suicidality syndrome independent of specific major psychiatric disorder? Results of a split half multiple regression analysis. Acta Psychiatrica Scandinavica, 94, 79–86
(1997). Neurotransmitters and suicidal behavior: The evidence from cerebrospinal fluid studies. In DM Stoff, JJ Mann (Eds.), The neurobiology of suicide. From the bench to the clinic. New York: Annals of the New York Academy of Sciences, vol. 386
SPECT neuropsychological activation procedure with the Verbal Fluency Test in depressed patients (submitted).
(2001). Decreased frontal serotonin 5-HT2A receptor binding index in deliberate self-harm patients. European Journal of Nuclear Medicine, 28, 175–182
(1996). Suicidal behavior runs in families. A controlled family study of adolescent suicide victims. Archives of General Psychiatry, 53, 1145–1149
(1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 30, 975–990
(1996). 5-HT, antidepressant drugs and the psychosocial origins of depression. Journal of Psychopharmacology, 10, 31–38
(1997). The prefrontal cortex: Anatomy, physiology and neuropsychology of the frontal lobe (3rd ed.). Philadelphia: Lippincott-Raven
(1998). Frontal lobe function and dysfunction. In PJ Snyder, PD Nussbaum (Eds.), Clinical neuropsychology. Washington DC: American Psychological Association
(2001). Neurobiology of suicide and attempted suicide. In Wassermann, D (Ed.), Suicide: An unnecessary death. London: Martin Dunitz
(2000). A serotonin transporter gene promoter polymorphism (5-HTTLPR) and prefrontal cortical binding in major depession and suicide. Archives of General Psychiatry, 57, 729–738
(1997). Frontal 5-HT2A receptors studied in depressive patients during chronic treatment by selective serotonin reuptake inhibitors. Psychopharmacology, 133, 99–101
(1999). Stress and the aging hippocampus. Frontiers in Neuroendocrinology, 20, 49–70
(1999). Neuropsychological factors associated with borderline pathology in children. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 770–774
(2000). From arousal to cognition: the integrative position of the prefrontal cortex. In HBM Uylings, CG van Eden, JPC de Bruin, MGP Feenstra, CMA Pennartz (Eds.), Cognition, emotion and autonomic responses: The integrative role of the prefrontal cortex and limbic structures. Amsterdam: Elsevier
(2000). Biological aspects of suicidal behavior. In K Hawton, K van Heeringen (Eds.), The international handbook of suicide and attempted suicide. Chichester: Wiley
(2000). Cortisol in violent suicide attempters: association with monoamines and personality. Journal of Affective Disorders, 60, 181–189
Prefrontal 5-HT2A receptor binding index, hopelessness and personality characteristics in attempted suicide. Journal of Affective Disorders, (in press)
(2001). About the biological interface between psychotraumtic experiences and affective dysregulation. In K. van Heeringen (Ed.), Understanding suicidal behavior: The suicidal process approach to research, treatment and prevention. Chichester: Wiley
(1998). Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but no major depression. American Journal of Psychiatry, 155, 543–547
(1997). The cry of pain. Understanding suicide and self harm. London: Penguin
(2001). Psychological aspects of the suicidal process. In K. van Heeringen (Ed.), Understanding suicidal behavior: The suicidal process approach to research, treatment and prevention. Chichester: Wiley