We need to support those experiencing suicidal thoughts, freeing them from the shame and stigma that surrounds suicide. — 123rf.com
On New Year’s Day, Master Sergeant Matthew Alan Livelsberger reportedly blew himself up in a Tesla Cybertruck in an apparent suicide outside the Trump International Hotel in Las Vegas, Nevada, United States.
Despite having a successful career as a Green Beret (member of The US Army Special Forces) and being the father of a baby born just last year, Livelsberger reportedly suffered from severe post traumatic stress disorder (PTSD) and depression.
This is just one high-profile example of how depression and anxiety disorders, ineffectively treated, can have lethal consequences.
Rates of PTSD combined with anxiety disorders or diagnoses of depression increased by 177% and 138% in only five years, from 2019 to 2023, according to the most recent edition of the Medical Surveillance Monthly Report, a peer-reviewed journal of the Armed Forces.
Skyrocketing rates of depression and anxiety are also being seen in civilian adults and, alarmingly, in our nation’s children.
According to a recent behaviour risk survey from the Centers for Disease Control and Prevention, almost 40% of children in ninth through 12th grade experienced persistent feelings of sadness and hopelessness, and 20.4% seriously considered attempting suicide.
Compounding this crisis in mental health is our inability to treat depression and anxiety effectively in most people.
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertralin and paroxetine, the first line of medical therapy for these mood disorders, induce symptom improvement in only half of those people taking them and place only a third into remission.
Unintended side effects of SSRIs, including anxiety itself, suggest that SSRIs may actually cause some of the symptoms they are meant to reverse.
In pregnant women, SSRIs cross the placenta and are absorbed into breast milk; they may affect foetal development and cause disorders of gut-brain interaction.
In short, we need better therapies for depression and anxiety, and we need them as soon as possible.
Disturbingly, however, the budget provided for mental health research by the National Institutes of Health, the premier source of funding for US medical research, actually decreased last year.
A photo of Matthew Alan Livelsberger is shown as Sheriff Kevin McMahill talks to the media at the Metropolitan Police Department headquarters in Las Vegas after the vehicle explosion incident. — Las Vegas Review-Journal/TNS
Via the brain or gut?
Emerging research in mental health is showing how little we know and thus how much work needs to be done, including in how SSRIs work.
SSRIs increase serotonin, which has been called the “happy hormone” due to its anti-depressive and anti-anxiety effects.
Since fluoxetine made a splash in the 1980s, the general scientific consensus has been that SSRIs enter the bloodstream and help anxiety and depression by increasing serotonin directly in the brain.
While serotonin is found in the brain, more than 90% of our bodies’ serotonin actually is found in the gut.
Furthermore, SSRIs are systemically absorbed, leading to an increase in serotonin levels in not only the brain but also the gut.
This leads to a key question – when SSRIs help anxiety and depression, is that because they increase the serotonin in the brain, or because they increase the serotonin in the gut?
In other words, might it be better to target anxiety and depression by focusing on the gut, thus increasing efficacy of the SSRIs and reducing their harmful side effects?
I recently published a study in animals that shows that increasing serotonin specifically in the gastrointestinal tract improves anxiety and depression.
This suggests that a medication that can increase serotonin in the gut, while not entering the bloodstream, may be a more effective treatment for anxiety and depression while also avoiding foetal exposure in women taking SSRIs. (Pregnant women should not stop taking SSRIs when their physicians think they are required, as maternal depression itself can have its own negative effects.)
It is critical, however, that studies focusing on how the gut affects mental health be at the forefront of political and scientific policies.
Call for action
With a new presidential administration, there must be a key focus on prioritising mental health initiatives.
The formation of the bipartisan Senate Mental Health Caucus has been a very positive start.
An even more robust effort, similar to the White House initiative “Cancer Moonshot,” would be required.
This revolutionary initiative is building new collaborations and programmes across all parts of the cancer community, including the federal government, private companies, health care providers, patient groups, philanthropies and the general public.
Many facets of Cancer Moonshot could be implemented in the mental health sphere.
These could include investments in widespread screening and preventative programmes; access to quality, coordinated care; the implementation of navigation services to enable patients to more easily acquire services; and prioritised research funding directed toward new treatments and preventative measures.
Importantly, all of these measures consider equity for all populations and also consider military members and children specifically.
As with the Cancer Moonshot initiative, these actions would require the collaboration of the government, private companies, nonprofits, academic institutions and patient groups.
Let’s make the case of Livelsberger a call to action for all who suffer from mental health conditions.
On a policy level, we should encourage our local governments and the senators in the Mental Health Caucus to prioritise mental health education, research and access.
On a personal level, we can support people we know who are struggling, take part in mental health awareness events or volunteer in a mental health organisation.
Most importantly, if you are struggling, seek the personal and professional help you need to take care of yourself.
Prioritise mental health – our lives depend on it. – Chicago Tribune/Tribune News Service
Kara Margolis is director of the New York University Pain Research Center, a professor in the Department of Molecular Pathobiology at the NYU College of Dentistry and in the Departments of Cell Biology and Pediatrics at the NYU Grossman School of Medicine. She is also one of the Public Voices Fellows at NYU.
Those suffering from mental health issues or are contemplating suicide can reach out to the Mental Health Psychosocial Support Service (03-2935 9935 or 014-322 3392); Talian Kasih (15999 or 019-261 5999 on WhatsApp); Jakim’s Family, Social and Community care centre (011-1959 8214 on WhatsApp); or Befrienders Kuala Lumpur (03-7627 2929, visit www.befrienders.org.my/centre-in-malaysia for a full list of numbers and operating hours, or email sam@befrienders.org.my).
