From The Quarterly, Spring 2013
Roughly 36,000 Americans kill themselves every year. Is it possible to develop better ways to predict and avert suicide? J. John Mann, M.D., believes the answer is “yes.”
Dr. Mann is a pioneer in the study of factors that predispose people to depression, bipolar disorder and suicide. He is currently leading one of the largest studies of causes of suicidal behavior ever mounted, with dual goals of developing a biological screening test to estimate the risk of suicidal behavior and for evaluating therapeutic interventions that will relieve the desperation that leads to suicidal behavior.
Using brain-imaging technology, the team is using information from the brains of people who died by suicide to develop brain-imaging methods that they are testing in depressed patients, half of whom have a history of suicidal behavior and half who have never attempted suicide.
The postmortem studies have revealed specific, consistent changes in certain neurotransmitter systems, and the team is trying to see if the same changes are visible in the living patients. Patients exhibiting the abnormality are being followed to see if the brain imaging findings predict outcome on different types of medication and psychotherapy treatments.
One promising intervention Dr. Mann is testing is the drug ketamine. Originally developed as an anesthetic, ketamine has the ability to ease the symptoms of major depression within a few hours, as opposed to currently available antidepressants, which often require weeks to take effect, if at all. In current trials of ketamine with suicidal patients, about 60 percent have gotten better, a percentage that appears to be higher than achieved with other medications. These patients are then continued on other medication and followed over a period of several months.
Dr. Mann credits the Brain & Behavior Research Foundation for this research. His 2008 NARSAD Distinguished Investigator Grant afforded him the opportunity to conduct preliminary studies of the response of patients to ketamine while simultaneously scanning their brains with magnetic resonance imaging (MRI). The results of that preliminary trial led to the current ongoing studies, both of which are being funded by the National Institute of Mental Health (NIMH).
“I would never have gotten initial funding from the NIMH because I had no pilot data,” he says.
“After many years of mapping neurotransmitter abnormalities in the brains of people who died by suicide,” says Dr. Mann, “we are now beginning to detect the same kinds of abnormalities in the brain scans, which means that the possibility of using a brain scan in addition to clinical assessment to detect depressed patients at risk for suicide is becoming a very real option for clinicians.”
J. John Mann, M.D.
Paul Janssen Professor of Translational Neuroscience in Psychiatry and Radiology,
Director of the Molecular Imaging and Neuropathology Division,
New York State Psychiatric Institute;
2008 NARSAD Distinguished Investigator Grantee,
Brain & Behavior Research Foundation Scientific Council Member