Toxic Stress, Glutamate and the Path to Suicide

Suicide is the nation’s 10th leading cause of death, and the second leading killer for those ages 15-34. There are on average 40,000 suicides each year, having reached its highest rate in 25 years per the latest CDC report. Every year, 1 million adults will attempt suicide, with 2.2 million more making suicide plans, and another 8.3 million having suicidal thoughts (1). Why would so many people contemplate, plan, attempt, and end their life? Could it be that parents, unknowingly, are setting their children up for the risk of suicide?

This is what a very enlightening, medical research study, called the Adverse Childhood Experiences (ACE) Study, suggests. It is the largest, most important study of its kind, which shows correlation of a child’s past adverse experiences to the multiple risk factors for several of the leading causes of death in adults. The study concluded that the greater the number of adverse experiences a child was exposed to, the more significant the increase in risk for major health problems later in life – ischemic heart disease, cancer, chronic lung disease, skeletal fractures, liver disease, depression and suicide (2,3).

In conducting the research, the ACE Study compared the health status of over 17,000 adult participants to 7 categories of adverse childhood experiences. These experiences included physical, emotional or sexual abuse, neglect or abandonment, growing up in a household with an alcoholic or a drug user, witnessing domestic violence, living with someone who was chronically depressed, mentally ill or suicidal, parental separation or divorce, or growing up where someone was imprisoned. To better analyze this huge mass of information that was gathered, concerning the participants, a questionnaire with an ACE Score was constructed. An individual exposed to none of these categories had an ACE Score of 0, while an individual exposed to any four would have an ACE Score of 4, and so on.

The findings were startling! The study revealed that childhood experiences are common and that they “DRAMATICALLY” impact adult health, most especially depression. Furthermore, there was a strong relationship between the number of categories, contributing to the ACEs Score, and a participants’ lifetime history of depression. It is well known that depression is the greatest risk factor for suicide. According to the National Institute of Mental Health, “Depressive disorders affect approximately 16 million American adults” (4). However, the most striking information in the study showed that an individual with an ACE Score of four or more was “460%” more likely to be suffering from depression than an individual with an ACE Score of zero. It was additionally found that there was a “1,220%” increase in the history of attempted suicides between these two groups. An ACE Score of at least 7 (categories, not incidents) increased the likelihood of childhood/adolescent suicide attempts 51-fold and adult suicide attempts 30-fold (3,000-5,100%)! Using the analytic technique of population attributable risk, the study’s co-investigators, Dr. Vince Felliti with Kaiser and Dr. Bob Anda with the CDC, found that about “80%” of attempted suicides could be attributable to adverse childhood experiences (5,6) which have become known as “toxic stress”.

Stress is experienced throughout our lives, such as encountered on the first day of attending school, starting a new job, or meeting new people. More intense examples include facing the death of a loved one, a natural disaster, or witnessing a frightening accident. These types of stresses are a part of life, and with the love and support of family and friends, they are eventually overcome.

Toxic stress, however, is not easily overcome and can take place over long periods of time – days, months or even years. Toxic stress was never meant to be a part of our lives, especially as a child growing up. Under normal stress-related circumstances, stress hormones such as adrenaline and cortisol are immediately released and then, when the stress ends, these hormones are quickly removed. However, when toxic stress occurs, these same hormones are released, continuously streaming throughout the body. Their quick removal ceases to happen, causing a constant inflammatory response to take place. It is this relentless, intensive, and prolonged type of stress, and the inflammatory response that makes these hormones, in particular cortisol, so highly toxic. To incite even greater harm, cortisol creates a surplus of a neurotransmitter called glutamate (7). High levels of glutamate become extremely toxic to the brain resulting in damage to multiple brain structures and functions, which is why it must be quickly removed by glutathione, the major protector of the brain (8). Unfortunately, this extra glutamate may not be quickly removed if a person’s glutathione levels have been compromised. Interestingly, a recent study found suicide attempters with the strongest desire to kill themselves correlated with having high glutamate levels. After their suicidal behavior had ended, results showed their levels had returned to normal (9).

The biological processes that occur when children are exposed to stressful events can disrupt early development of their central nervous system. This may adversely affect brain functioning later in life (10). Toxic stress events can:

Impair the connection of brain circuits and, in the extreme, result in the development of a smaller brain (11).
Cause an individual to develop a low threshold for stress, thereby becoming overly reactive to adverse experiences throughout life (11).
Suppress the body’s immune response. This can leave an individual vulnerable to a variety of infections and chronic health problems (11).
Damage the hippocampus, an area of the brain responsible for learning and memory. These cognitive deficits can continue into adulthood (11).

Toxic stress also contributes to numerous health risk behaviors such as alcohol abuse, drug abuse, obesity, sexual risk behavior and smoking; as well as short- and long-term negative health effects that are SIGNIFICANTLY increased throughout a child’s adult life. These include:

frequent headaches and migraines (12)
hallucinations (13)
impairment in multiple brain structures and functions (14)
depression, depressive disorders, mental illness & using prescribed psychotropic medications (15,16,17,18)
suicide attempts (19)
ischemic heart disease (3,20)
liver disease (3,21)
chronic obstructive pulmonary disease (3,22)
skeletal fractures (3)
lung cancer (3,23)
autoimmune diseases (24)
endocrine disorders (25)

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In summary, out of all the top ten causes of death, suicide is the only one that has significantly increased (26). Eighty percent of the estimated 1 million attempted suicides each year can be attributed to adverse childhood experiences. These experiences create toxic stress which produces an on-going inflammatory response. This leads to the production of excess glutamate which must be quickly removed by our body’s limited resource of glutathione, “the key” to living a long and healthy life. As glutathione is depleted, glutamate is not quickly removed and contributes to weakening the architecture of the developing brain, with long-term consequences for learning, behavior, and both physical and mental health.

Every person has a breaking point, mentally, emotionally, psychologically, physically, and socially. Toxic stress is poisonous to the brain. It lowers one’s threshold, majorly shortening the length of time that it takes for someone to reach that breaking point. This is an accumulative affect starting from the moment of conception, continuing throughout one’s adult life.

Reducing the risk of suicide begins with our children. They are each a blessing from God. We can no longer just “count their fingers and toes, and feel assured that all will be well. It is going to take a community of caring adults – parents, grandparents, aunts, uncles, teachers, and physicians – all working together to provide safe, caring, and nurturing environments where every child feels loved. Children & adolescents exposed to the unrelenting stress caused from living in adverse experiences need someone they can trust and turn to when a problem arises. It is our obligation to see that their needs are met and let them know that their life matters. This is how we begin to decrease the risk of suicide!

What is your ACE Score; and more importantly, what ACE Score will your child have as an adult?

“Love never fails.” (1 Corinthians 13:8)

References:

(1) www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf

(2) www.cdc.gov/violenceprevention/acestudy/

(3) www.ncbi.nlm.nih.gov/pubmed/9635069

(4) www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

(5) http://jama.jamanetwork.com/article.aspx?articleid=194504

(6) www.acestudy.org/files/Gold_into_Lead-_Germany1-02_c_Graphs.pdf

(7) www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/

(8) www.ncbi.nlm.nih.gov/pubmed/24752591

(9) www.nature.com/npp/journal/v38/n5/full/npp2012248a.html