June 20, 2018 - The Record

TUC Record: Special Edition Suicide Prevention


A Note from Our Provosts

We at Touro wanted to take this opportunity to come together as a community to address the growing number of deaths by suicide in this country. Suicide affects people from every walk of life, and each tragic death is a reminder that we cannot be silent any longer.

Shelley Berkley

We hope that the resources, facts, and ideas contained in this newsletter will help educate and inform our readers about an issue that affects so many families and often leaves us feeling helpless. By speaking out as a community, we can help people struggling with depression and save lives. 

- Shelley Berkley, JD
Chief Executive Office and Senior Provost for Touro University Western Division


In the United States, suicide rates have risen by almost 30% since 1999. Suicide knows no boundaries with increases in all sexes, racial and ethnic groups, across ages, and across socioeconomics.

Sarah Sweitzer

As the 10th leading cause of death, suicide is one of three leading causes of death that is increasing. As an academic institution dedicated to the medical health sciences, public health, and education, we at TUC feel that there is no time like the present to come together in open dialogue to talk about suicide, expand awareness of suicide warning signs, and identify prevention strategies in our communities. Working together, we can reduce suicide in our community.  

- Sarah Sweitzer, PhD
Provost and Chief Academic Officer for Touro University California

High-functioning Depression: How to Help

How to help those you suspect may be suffering from depression

  • Pay attention to loved ones. If they stop responding, ask questions. Be direct. If you suspect that someone is struggling currently or has in the past suffered from depression or had a suicide attempt be direct by asking “How has your mood been? Are you having suicidal thoughts? How can I help?” After you ask, listen.
  • If someone says they are have suicidal thoughts, focus on their reasons for living. Do not impose reasons of your own onto them.
  • Follow up is very important, especially if an attempt has been made before. Follow ups have been shown to reduce further suicide attempts, and small gestures mean a lot. While it is a common conception that people die from suicide when they are at their lowest point, action is often taken when a person has an upswing in mood when they feel like they have the energy to act on the thoughts of hopelessness that they have been feeling.
  • The response that it is selfish to die by suicide is cold and can prevent people from expressing themselves. Keep in mind that these people are suffering from deep despair.

Help them connect to resources


In Crisis:

National Suicide Prevention Lifeline (24 hr):
Trevor Lifeline for LGBTQ (24 hr): 1-866-487-7233

TUC Students: Call 707-638-5292, choose option #3 to be connected to a counselor, 24/7. Students also have access to TUC's Employee Asssistance Program program at 1-800-999-7222

High-functioning depression can be difficult to see even when you have regular, close contact with individuals who are struggling. It is often a shock to realize that someone who has made a clearly meaningful contribution to the world could have felt so isolated or despairing as to consider suicide. After suicide, those who have just seen the person will often say that they seemed okay; everything seemed fine.

High-functioning depression has atypical symptoms, says Marcia Greene, Counselor at Touro Universtiy California's (TUC) Student Health Center. People suffering from it are often high achievers, expect a lot of themselves, and yet can still feel not “good enough.” However, they put up a positive front are often quite accomplished and educated while keeping their inner turmoil hidden. Because those with high-functioning depression are often engaged in professions where there are very high stakes, the stigma that surrounds depression can be amplified, making it difficult for them to reach out to their support network to get help.

Marcia Greene“Many cases of depression and suicidal ideation aren’t caught because others don’t see it behind the facade,” explains Ms. Greene. “Those with high-functioning depression are isolated, but maybe not in obvious ways. They’re sad, but might not come out and say that they want to kill themselves. They may say things like “I’m so exhausted that I can’t do this anymore” or “I just want a break from it all.”

Like all depression, high-functioning depression is treatable, and there are resources and tools available to help friends and loved ones.

“We all need to be having conversations about mental health and mental illness,” says Ms. Greene.


A Few Questions from Your Medical Care Provider Can Save Your Life

People suffering with the risk factors for suicide step through clinic and hospital doors every day. They seek medical care when their quality of life has diminished from age, illness, or chronic pain, but many stay silent about their emotional pain and keep it to themselves. But medical caregivers can help break this terrible feeling of isolation by taking a moment to ask a few direct questions that can ultimately save lives.

Dr. Jeffrey Zwerin“One of the things most people don’t realize, is that assessing and preventing suicide isn’t primarily done by a psychiatrist, says Dr. Jeffrey Zwerin, psychiatrist and Assistant Professor of TUC’s College of Osteopathic Medicine. “Patients who are depressed and are considering suicide will typically come to see their primary care practitioner, not a psychiatrist.”

Dr. Zwerin teaches doctor of osteopathic medicine and physician assistant students at TUC how to perform a suicide risk assessment with their patients. The risk assessment entails asking questions such as: “Have you had thoughts of hurting yourself?”, “Do you feel hopeless?”, and “Have you developed a plan to hurt or kill yourself?”

“There is a myth that if a patient is asked if they have had any thoughts about hurting themself, that doing so will put the idea into their head, and that patient will then go out and do it,” explains Dr. Zwerin. “But the truth is, if a clinician doesn’t ask a depressed patient about suicidal thoughts, it gives that patient the impression that the clinician does not want to or is afraid to talk about suicide with you. Studies have shown that if you raise the question of suicide, it allows patients to open up.”

There are many risk factors beyond depression that also put a person at higher risk for suicide. They include:

  • Alcoholism and drug addiction
  • The sudden loss of a job or one’s spouse
  • Mental health disorders
  • Chronic health conditions and chronic pain
  • Having made a prior suicide attempt

Once they have completed a suicide risk assessment, medical caregivers can make the right decisions to assure their patients are appropriately referred and receive treatment as soon as possible.

“If someone is actively thinking of suicide, that is the same as another patient coming to the emergency room with severe chest pain and found to have had a heart attack,” stresses Dr. Zwerin. “We have to take the same emergency measures to treat them because depression is treatable and in many instances suicide can be prevented! We can get them over that hump and get them on the road to recovery. We can help them.”

Treating Depression: New Pathways to Change

Dr. Kelan ThomasIn the effort to treat depression, a novel therapy is emerging that attempts to disrupt the dysfunctional neural network circuits of depression entirely. Set in a clinical setting, psilocybin-assisted therapy involves a 6 to 8 hour session of guided medical use structured by talk therapy before, during, and after the medication session. Psilocybin-assisted therapy can help a person find insight on how he can reconnect with himself and the people around him, according to Dr. Kelan Thomas, Assistant Professor of Clinical Sciences at TUC’s College of Pharmacy.

“There are no objective test results to determine who has depression and who doesn’t—no brain scans or blood tests, things of that nature,” explains Dr. Thomas. “There are now companies that perform genetic tests and claim they can improve treatment for depression, but the evidence is weak and researchers have had significant financial conflicts of interest.”

The active compound found in hallucinogenic mushrooms, psilocybin is currently beginning phase 3 clinical trials in both the US and the UK with the intention of gaining Food and Drug Administration (FDA) and European Medicines Agency (EMA) approval for the treatment of depression.

As of yet, many of the studies involving psilocybin have treated people with a life threatening diagnosis, providing therapy aimed at reducing the anxiety and depression symptoms surrounding the terminal illness. But Dr. Thomas stresses that more research needs to be done.

“People have these insights, and with the corresponding shifts in these neural networks, they can integrate them into their daily life to help prevent depression,” says Dr. Thomas. “For a person with these ruminating negative thoughts and feelings of disconnection, they will often describe the psilocybin-assisted therapy session as giving them a felt sense of meaning and reconnection.”

Traditional antidepressants alleviate the symptoms of depression by delivering an influx of serotonin, which modifies neural connections and improves the symptoms of depression. In the most severe and drug-resistant cases of depression, additional treatment options like Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) attempt to disrupt the same dysfunctional pathways by sending small electric or magnetic signals to the brain. And looking on the horizon, Dr. Thomas adds that a new esketamine medication is currently seeking approval by the FDA.

“The best theory of depression is that there are these dysfunctional circuits in the brain,” explains Dr. Thomas. “All of the possible treatments cause changes or reset these neural networks in the brain.”

Dr. Thomas's article: Psilocybin-Assisted Therapy: A Review of a Novel Treatment for Psychiatric Disorders

National Institute of Mental Health Resouces on Mental Health Medications

Youth Suicide

By Tami Hendrriksz, DO, Associate Professor and Assistant Dean for Clinical Integration, College of Osteopathic Medicine

Dr. Tami HendrikszSuicide is a serious issue that affects many of our young people, and it is becoming increasingly prevalent. According to the Centers for Disease Control, suicide is the third leading cause of death for youth between the ages of 10 and 24 years. Three times as many teens and young adults commit suicide now, as compared to the 1940’s. Currently we lose about 4,600 youth to suicide every year. But that is only part of the picture. Many more young people survive suicide attempts compared to those who die by suicide. Emergency Departments across the United States treat about 157,000 youth between the ages of 10 and 24 years for self-inflicted injuries.  

Studies have shown that there are some factors that put certain youth at greater risk of attempting suicide when compared to others. The greatest risk factors for youth suicide include a personal history of depression or other mental health problems, exposure to suicidal behavior by others (such as classmates or family members), easy access to guns or other lethal means, and social isolation. Simply having risk factors does not mean that a young person will attempt suicide.

There are a number of warning signs to watch for when young people are thinking about attempting suicide. It should always be taken very seriously any time a young person begins to talk about or threaten suicide. That is one of the biggest warning signs. Other warning signs include increased substance abuse, feelings of hopelessness or purposelessness, withdrawing from people and activities, and unusual anger or recklessness. Suicide awareness and prevention is crucial to helping to decrease the number of suicide attempts in our youth. Programs promoting suicide prevention include awareness programs in schools and communities, peer support programs, crisis intervention centers, suicide hotlines, counseling and clinical interventions.

Reach the 24-hour National Suicide Prevention Lifeline at 1-800-273-8255 [TALK].

This issue does not contain medical advice. It is for educational purposes only. It does not represent the views of Touro University California.