June 2, 2019, Charleston (SC) Post and Courier: As teen suicide rates rise, brain imaging is starting to answer questions of why https://www.postandcourier.com/health/as-teen-suicide-rates-rise-brain-imaging-is-starting-to/article_7df98292-7275-11e9-84a4-5fc36ae3a720.html In the note Aaron Williams wrote before dousing himself with gasoline, he explained that he’d wanted to become a doctor when he grew up. To help people. Instead, the 16-year-old printed in stiff black letters, “I can’t even help myself.” He hoped that his high school’s faculty would realize kids like him “have feelings like I do right now.” Aaron himself couldn’t understand what he was feeling, or how he’d come to this moment. He pulled onto the busy campus of his school, Academic Magnet High in North Charleston, and parked. Then, he lit himself on fire. His autopsy report arrived at his Mount Pleasant home in an envelope. His father, Trace, read it right away. His mother could not bear to until months later. Yet, it contained answers to why such a sweet and docile boy would end his life in this fashion. Aaron had multiple lesions in his amygdala, structures in the brain’s limbic system that play critical roles in processing emotions — notably anxiety and fear. … Suicide deaths across all ages have risen nationwide for almost two decades, and South Carolina has seen the biggest jump in the Southeast at 38 percent, federal data shows. Suicide is now the second-leading cause of death among teens and young adults here. In 2007, 13 youth ages 10 to 19 in South Carolina took their lives, state data shows. A decade later, 51 did in a year’s time. Yet, as those figures rise, modern imaging also is opening critical new views into the living brain. Scientists are discerning far more about the biology of suicide, a key factor to knowing why this is happening. And how to address it. … One key area is the amygdala, where Aaron’s brain suffered damage. The next frontier… Just as the fMRI stepped onto the world’s scientific stage, a young Dr. Mark George, trained in psychiatry and neurology, arrived at the National Institutes of Mental Health in D.C. He became fascinated with brain imaging and was among the first to use it to spot differences in the brain activity of people who have depression and mania. … We now know that disorders like depression and anxiety, once seen as character flaws (If he’d only buck up and get over it!), often result from malfunctioning biology, much like we know about cancer and cells. Dr. Mark George has used modern brain imaging to devise brain stimulation techniques that can help treat depression. James Arrowood of Ralph H. Johnson VA Medical Center Public Affairs Office/Provided From his MUSC office, George explains. Think of the limbic system, nestled deep within the central brain, as a hub where emotions like fear and pleasure emerge. The amygdala is part of this system. When those emotional responses head up into a healthy prefrontal cortex, particularly its orbitofrontal cortex just behind your eyes, that region acts like a braking system to the emotions. In people who suffer depression and suicidal thoughts, those brakes can be faulty. In adolescents, already grappling with hormones and heightened emotions, the prefrontal cortex typically isn’t fully developed yet, one reason they’re known for impulsive decision-making. This also could put them at greater risk of acting on suicidal thoughts. … But how can we tell normal teenage rates of brain maturity from chronic deficiencies that put some youth at greater risk of acting on suicidal thoughts? We can’t, not yet. Most of what we have learned from modern brain imaging is based on scans of people over 21, not adolescents…. Biology, however, isn’t the only factor that drives suicidal ideation. Environment also plays a role, experts say, and the reality is: adolescent life has changed. For almost 20 years, the federal government’s Youth Risk Behavior Surveillance System survey has provided glimpses into the lives of teenagers. And among South Carolinians who responded over the past decade, every measure that relates directly to suicide has risen, especially among girls. (Boys are far more likely to die of suicide while girls more often attempt it.) The most recent survey, done in 2017, found that nearly one in four high school girls said they had seriously considered it over the past year. That was up 6.5 percent in a decade. …. Family conflicts, onset of puberty, social media and bullying play roles. So does a huge spike in substance abuse rates, said Alex Karydi, head of the S.C. Department of Mental Health’s suicide prevention center. Then there’s the ever-bubbling cauldron of pressure they face. … Among the national survey’s most striking findings is the steep rise in high school girls who reported feeling sad or hopeless over the past year almost every day for two weeks or more in a row, to the point they stopped doing some usual activities. It is a key indicator of depression. A stunning 43 percent of girls said they’d experienced this — an 11 percent increase over a decade. About one-third of boys did, too. Some experts blame social media. But research shows mixed results. … Indeed, over the month after the show’s 2017 debut, suicide deaths among children aged 10 to 17 rose 29 percent, according to a federal study. But ultimately, these are statistics. They don’t tell us why.