ROCHESTER, Minn. — Mayo Clinic researchers have discovered that people with major depressive disorder and a history of attempted suicide have distinct biomarkers that correlate with their response to antidepressant therapy. The new findings, published in Frontiers Pharmacology, are key to individualized treatment strategies and early identification of patients who are at the highest risk for suicide.  

For the study, the researchers used multi-omics technologies — specifically, metabolomics and genomics — to analyze samples from 350 patients with major depressive disorder. They compared samples of patients with and without a history of suicide attempt(s) and found distinct blood-based multi-omics signatures between the two groups, despite all patients having the same diagnosis of major depressive disorder.  

Nearly 700,000 people worldwide die by suicide every year, along with 10-20 times as many non-fatal suicide attempts, according to the World Health Organization. A prior suicide attempt is the highest risk factor for suicide in the general population. 

“Evaluating suicidal patients can be challenging because clinical risk assessments are inherently subjective and major depressive disorder has high degrees of variability,” says Paul Croarkin, D.O., M.S., a psychiatrist in Mayo Clinic’s Department of Psychiatry and Psychology, and senior investigator of the study. "Our study lays a foundation for advancing the prognostic potential of this disease and enhancing patient outcomes that use both biological and digital biomarkers."

The team found that variations in the genes CLOCK and ARNTL differentiate in patients with and without a prior suicide attempt. Both genes are related to the circadian rhythm, which regulates critical functions in the body, including behavior, metabolism, hormone levels and sleep. These specific gene variations are also associated with lower antidepressant response and remission rates. 

Metabolomics is the study of metabolites, which are substances created when the body breaks down food, drugs or its own tissue. Genomics is the study of genes, which can influence enzymes that are crucial for metabolizing medicines. While individually they explain aspects of biological processes, analyzing them jointly has potential of revealing interactions that were previously not studied.  

Altogether, multi-omics is a combination of two or more "omics" approaches. Additional multi-omics examples include proteomics, the study of proteins; epigenomics, the study of epigenetic changes on DNA; and transcriptomics, the study of RNA molecules.  

By simultaneously evaluating the genome and metabolome, the researchers discovered biological signatures that could not be found by the genome or metabolome alone. 

The study is part of ongoing efforts at Mayo Clinic to understand the biology of suicidality to improve diagnostic approaches, treatments, and outcomes for patients with depression and other mood disorders. 

The study was led by researchers within Mayo Clinic's Department of Molecular Pharmacology and Experimental Therapeutics in the Center for Individualized Medicine and the Department of Psychiatry and Psychology. It demonstrates team science using large datasets to address challenges of individualizing medicine practices of globally devastating diseases. 

Acknowledgments 

This work is supported by the Harry C. and Debra A. Stonecipher Predoctoral Fellowship at the Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Summer Undergraduate Research Fellowship, National Science Foundation (NSF) under grant IIS-2041339; R01 MH113700, R01 MH124655, Blue Gator Foundation, and the Mayo Clinic Center for Individualized Medicine. 

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About Mayo Clinic   
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact:   

• Susan Murphy, Mayo Clinic Communications, newsbureau@mayo.edu   

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You can take steps to help a loved one cope with stress brought on by a traumatic event, whether it's a result of an accident, violence of any kind — such as an assault; verbal, physical, domestic or sexual abuse; or military combat — or another type of trauma.

A person with acute stress disorder (ASD) has severe stress symptoms during the first month after the traumatic event. Often, this involves feeling afraid or on edge, flashbacks or nightmares, difficulty sleeping, or other symptoms. If your loved one has symptoms that last longer than a month and make it hard to go about daily routines, go to work or school, or handle important tasks, he or she could have post-traumatic stress disorder (PTSD).

Whether your loved one has ASD or PTSD, assessment and counseling (psychotherapy) by a professional can make a critical difference in recovery. Encourage him or her to talk to a doctor or a trained mental health professional.

You can also help by being a supportive listener, without attempting to "fix" the situation. Here are some suggestions:

• Be willing to listen, but don't push. Make sure your loved one knows that you want to hear about his or her feelings. But if the person isn't ready or willing to talk about it, don't push. Just reassure your loved one that you'll be there if and when he or she is ready.
• Choose a time to talk. When you're both ready to talk, choose a time and place where you'll be free of distractions and interruptions. Then truly listen. Ask questions if you don't understand something. But avoid any urges to second-guess, make assumptions, give advice or say, "I know just how you feel."
• Recognize when to take a break. If you sense that the conversation is becoming too intense for your loved one, provide him or her with an opportunity to stop for now and take up the conversation again on another day. Then follow through.
• Get help if talk of suicide occurs. If your loved one talks or behaves in a way that makes you believe he or she might attempt suicide, respond calmly, but act immediately. Make sure the person is not left alone. If it's safe to do so, you may want to discreetly remove pills, firearms or any other objects that could be used for self-harm, and get help from a trained professional as soon as possible.

If you think your loved one may attempt suicide, get help:

• Call 911 or your local emergency number immediately.
• Call a suicide hotline number. In the U.S., call the Suicide & Crisis Lifeline at 988 any time of day to talk with a trained counselor. Use that same number and press "1" to reach the Veterans Crisis Line.

Coping with traumatic stress is an ongoing process, and there is no specific time frame for recovery. You might have many conversations with your loved one over weeks or months as he or she processes the traumatic experience during or after a period of professional care.

You'll be of more help to your loved one if you learn about ASD and PTSD from trusted medical sources and encourage your loved one to follow treatment recommendations. You may need to help your loved one stay connected with healthy social supports.

And don't forget to take care of yourself. Coping with trauma that happened to a loved one can be difficult to deal with, and it can make it harder for you to help your loved one if you don't take care of yourself. Take time for the things you enjoy, accept help from others when needed and make an appointment to see a mental health professional if you're struggling to cope.

This article is written by Dr. Craig Sawchuk and Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

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Suicide rates are on the rise in the U.S., particularly in rural areas, according to a new study published in JAMA. The findings show that rates are highest in less-populated areas where people have lower incomes and fewer resources.

"I think it's confirming more than alarming," says Dr. J. Michael Bostwick, a Mayo Clinic psychiatrist who was not involved in the study.

Watch: Dr. J. Michael Bostwick discusses U.S. suicide rates.

Journalists: Broadcast-quality sound bites with Dr. J. Michael Bostwick are in the downloads. Please "Courtesy: Mayo Clinic News Network."

"We know that our rural areas are lacking in adequate medical care, adequate medical insurance among the people," says Dr. Bostwick. "We know that our rural areas have people that are making less money than urban people on average, who are less connected socially because distances are great and for whom public transportation is not available. We know that poverty and lack of access to health care and social isolation are all associated with higher rates of suicide and indeed the crisis in rural America is generally more about how the social fabric is fraying or being destroyed by all kinds of factors than specifically about suicide."

Dr. Bostwick says the key takeaway to lower suicide rates, communities need to have ways that people can be in connection with one another with access to adequate medical resources, both providers and insurance.

"The authors have made this point that their study is ecological, looking at the larger context in which suicide occurs, not about saving individual lives; this is a study that concludes that beefing up and strengthening communities is what's critical. So, for example, we need to have higher rates of health insurance, but also higher rates of access, so that people can get care for physical problems as well as mental problems. We need to find ways to make sure infrastructure is improved for rural communities."

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What to do when someone is suicidal
When people say they are thinking about suicide or act as though they may harm themselves, it can be upsetting. You may not be sure what to do to help. And you may not know whether you should take them seriously or if intervention might make the situation worse. Learn what you can do and how you can help someone who is suicidal.

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According to the Centers for Disease Control and Prevention (CDC), the rate of suicide in the U.S. increased 24 percent from 1999 to 2014. Suicide has long been thought of as a mental health problem, but the CDC now warns that it’s become a public health problem. National Suicide Prevention Week, Sept. 5 - 11, and World Suicide Prevention Day, Sept. 10, are efforts to increase awareness.

• Get the treatment you need. If you don't treat the underlying cause, your suicidal thoughts are likely to return. You may feel embarrassed to seek treatment for mental health problems, but getting the right treatment for depression, substance misuse or another underlying problem will make you feel better about life — and help keep you safe.
• Establish your support network. It may be hard to talk about suicidal feelings, and your friends and family may not fully understand why you feel the way you do. Reach out anyway, and make sure the people who care about you know what's going on and are there when you need them. You may also want to get help from your place of worship, support groups or other community resources. Feeling connected and supported can help reduce suicide risk.
• Remember, suicidal feelings are temporary. If you feel hopeless or that life's not worth living anymore, remember that treatment can help you regain your perspective — and life will get better. Take one step at a time and don't act impulsively. 

On Mayo Clinic Radio psychologist Dr. Craig Sawchuk discusses suicide prevention.
You can listen to the Mayo Clinic Radio 6/11/16 show.

More resource information:

• Suicide and suicidal thoughts risk factors
• Mayo Clinic Teen Suicide Prevention video
• Reach Out video
• Warning Signs a Teen Might be Suicidal
• NAMI
• Ruth Nearly Lost Her Life to Depression
• Thinking about suicide? How to stay safe and find treatment
• American Foundation for Suicide Prevention
• Suicide Prevention Lifeline
• American Association of SuicidologySuicide Prevention Resource Center

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Listen to the program on Saturday, June 11, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

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Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Listen to the program on Saturday, June 11, at 9:05 a.m. CDT.

Miss the show? Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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What should I do if I suspect my teen is suicidal?

If you think your teen is in immediate danger, take him or her to the emergency room or call 911, your local emergency number or a suicide hot line number — such as the Suicide & Crisis Lifeline.

If you suspect that your teen might be thinking about suicide, talk to him or her immediately. Don't be afraid to use the word suicide. Talking about suicide won't plant ideas in your teen's head. Ask your teen to talk about his or her feelings and listen carefully. Don't dismiss his or her problems or get angry. Instead, reassure your teen of your love. Remind your teen that he or she can work through whatever is going on — and that you're willing to help.

Warning signs of teen suicide might include:

• Talking about or hinting at suicide — for example, making statements such as "I'm going to kill myself," or "I won't be a problem for you much longer"
• Talking about or writing about death
• Increased use of alcohol or drugs
• Feeling purposeless or hopeless
• Withdrawing from social contact
• Mood swings
• Changing normal routine, including eating or sleeping patterns
• Acting recklessly or aggressively
• Giving away belongings or getting affairs in order when there is no other logical explanation for why this is being done
• Developing personality changes or being severely anxious or agitated
• Unexplained cuts or burns caused by self-injury

Learn more on mayoclinic.org.

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