Can hormone stabilization keep suicidal thoughts at bay for women?
Alyse Ruriani, 24, is living in recovery from the depression and suicidal thoughts that plagued her teenage years.
But every month she knows there's a possibility some symptoms could return—and it's timed to her menstrual cycle.
"Most days, I'm not feeling depressed," Ruriani said. "But I notice that the days I'm down, I'll check, and it always happens to be" just before menstruation.
"It's frustrating because I'm doing so well, and those weeks will come, and you don't feel so hot," she added.
University of Illinois at Chicago researchers are trying to help women who have a history of suicidal thoughts by looking at how the hormones estrogen and progesterone, which fluctuate during the menstrual cycle, can affect their mood. Researchers recently obtained a $3.1 million grant from the National Institute of Mental Health to further study how stabilizing these hormone levels in women at risk for suicide can keep suicidal thoughts at bay.
While health care professionals can identify who is at risk for suicide, it's hard to determine when they're most at risk, said Tory Eisenlohr-Moul, assistant professor of psychiatry at UIC and lead researcher on the new study.
"There's something of a crisis in suicide research over the last few years," she said. "We're good at predicting who is at risk for suicide ... but we are really not able to tell when someone will make a suicide attempt.
"We can't just say, you're a person who is at high risk for suicide, so we'll keep you in the hospital forever," she added. "We have to be able to predict when."
The study will track 90 females with a history of suicidal thoughts, providing estrogen and progesterone patches, or a placebo, during the time in their cycle when those hormones naturally drop. Previous research has already shown women at a higher risk for suicide are more likely to be hospitalized just before, during and just after menstruation, when hormone levels are at their lowest, Eisenlohr-Moul said.
Knowing this, over the past year, Eisenlohr-Moul has studied if stabilizing both estrogen and progesterone levels during that part of women's cycles could decrease suicidal thoughts. She's also involved in other research to see if one hormone is more responsible than the other.
The new study, however, will further that work by recording participants' mood, and trying to determine why these hormones affect women, and how they're metabolized.
The new study will also use an app that detects mood shifts in the way women type on their phones—not the words they use, but the speed at which they type and other factors, Eisenlohr-Moul said.
While researchers will also talk to participants about how they feel, it's not uncommon for people to hold back reporting suicidal thoughts for fear of being hospitalized and "losing their freedom," she said. The app will provide another way to measure feelings.
Eisenlohr-Moul said she hopes her work will lead to additional ways to treat women who experience suicidal thoughts, ultimately decreasing suicidal behavior.
Women attempt suicide three times more often than men, though men die by suicide more often, according to the American Association of Suicidology. Experts say this discrepancy is likely due to the methods women tend to choose in suicide attempts.
April Foreman, a Louisiana-based psychologist and executive board member for the American Association of Suicidology, said that despite an increase in suicide deaths, suicide research has lagged behind other health issues. And, it's important to study women specifically.
"We've known for a long time that the 70-kilogram man is not our only patient in health care," she said. "We also know that when it comes to suicide, there are gender differences."
The goal of this research shouldn't solely be preventing suicide deaths, Foreman said. Scientists also need to better understand how to decrease suicidal thoughts.
"Even if you don't die by suicide ... you feel like dying, and that is horrible," she said. "We should do better science to understand what controls that and tells us what we can do about it."
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