By Justine Dickhoff.
The role of the brain in suicide
Our brain is one of the most fascinating organs. Even though it only makes up 3% of our body weight it keeps our body running all day. It helps us to accomplish our work, go from place to place and let us understand when a friend needs a shoulder to cry on. As much as it helps us to master our daily life, it also contributes to less helpful processes. In individuals with a mental disorder, differences – sometimes referred to as abnormalities – in the brain have been found. These abnormalities cause our brain to give abnormal instructions which in the case of mental disorders lead to symptoms of e.g. depression or anxiety. Recently researchers have started to investigate which role the brain plays in suicidality.
So far, several brain regions have been pointed out to show abnormalities in size but also functions in individuals with suicidal thoughts or behavior. One example is the frontal cortex, an area associated with complex cognitive processes. Regions of the frontal cortex have been found to show differences in itself but also in communication patterns with other regions that are e.g. responsible for emotions . Abnormalities in these regions can cause one find it more difficult to search for solutions in an unbearable situation or have an increased focus on negative emotions, instead of neutral or happy ones . According to a review by Jollant and colleagues  in 2016 these are processes that lead one to evolve suicidal thoughts and sometimes, sadly, suicidal behavior. Knowing which brain regions are mainly involved in suicidality and related cognitive processes will, hopefully, give us an inside on which regions to approach for a treatment.
How knowledge about the suicidal brain could improve treatment
So far, giving the right treatment to a person experiencing suicidal thoughts and/or behaviors can be challenging. This is partly because we don’t have optimal treatments, yet. Medication, which is a common treatment given to those experiencing suicidal thoughts or behaviors, alters the function of brain regions and can therefore alleviate some symptoms. However, without knowing which brain regions are mainly involved in suicidality, it is more difficult to increase the efficiency of a treatment with medication. Apart from medication, a new treatment has also been put out. The new form of treatment is called neurostimulation. It is used to deliver mild electrical signals to certain regions of the brain. Some forms of neurostimulation are already in use as a treatment for patients with depression. And recently more and more research has also been conducted around neurostimulation in patients with suicidality. In a recent review this intervention has been found to alleviate suicidal thoughts , . Brain stimulation and pharmacological interventions are still under development and the search for the brain regions that should be targeted continues. More fine-grained knowledge of regions involved in suicide is therefore needed.
In Groningen we try to contribute to that.
Our research in Groningen (the Netherlands)
In Groningen we investigate brain patterns of individuals with really recent and severe suicide attempts (maximal six months ago). The goal is to capture changes in brain activity that happen as close as possible to the suicide attempt, so we can be sure to capture brain activity changes clearly distinguishable from other symptoms of a disorder. For our study we ask subjects to lie in the MRI scanner for about an hour and to perform tasks related to cognitive functions like emotion processing and regulation, processes that have been found to be impaired in individuals with suicidality. With these tasks we hope to get a clear picture of what is happening in the brain of individuals with a suicide attempt when they are busy with cognitive processes that are linked to suicidality. What we hope to find is a clearer picture about brain activity linked to suicidality. We want to pass on this knowledge to researchers investigating new treatment methods for individuals with suicidality. We hope, that with our research we can contribute to less deaths by suicide in the near future.
 Schmaal, L., van Harmelen, A. L., Chatzi, V., Lippard, E. T., Toenders, Y. J., Averill, L. A., Mazure, M. & Blumberg, H. P. (2019). Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Molecular psychiatry, 1-20.
 Pan, L. A., Hassel, S., Segreti, A. M., Nau, S. A., Brent, D. A., & Phillips, M. L. (2013). Differential patterns of activity and functional connectivity in emotion processing neural circuitry to angry and happy faces in adolescents with and without suicide attempt. Psychological medicine, 43(10), 2129-2142.
 Jollant, F. (2016). Neuroimaging of suicidal behavior. In Biological Aspects of Suicidal Behavior (Vol. 30, pp. 110-122). Karger Publishers.
 Serafini, G., Canepa, G., Aguglia, A., Amerio, A., Bianchi, D., Magnani, L., Dell’Osso, B., Pompili, M., Fitygerald, P.B. & Amore, M. (2020). Effects of repetitive transcranial magnetic stimulation on suicidal behavior: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109981.
 Bozzay, M. L., Primack, J., Barredo, J., & Philip, N. S. (2020). Transcranial magnetic stimulation to reduce suicidality–A review and naturalistic outcomes. Journal of psychiatric research.
Justine Dickhoff (@justinedickhoff) is a PhD student in the Cognitive Neuroscience Center of the University Medical Center in Groningen, the Netherlands. Email: firstname.lastname@example.org.