What Brain Imaging Reveals About People With Suicidal Thoughts

Trigger warning: This article discusses suicide and suicidal ideation. People with suicidal thoughts can call the crisis lifeline and 988 to receive free support. Resources are also available on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Why? It's the question that haunts us when a loved one dies by suicide or makes a suicide attempt. Sometimes, it seems like there are no warning signs, and people feel blindsided. And for the individuals who are in pain and have thoughts about ending their life, it's the unanswerable question. 

Why do I feel like this? 

Why can't I stop thinking this way? 

Why can't I find a way out of the pain?  

At Amen Clinics, we use a functional brain imaging technology called SPECT (single photon emission computed tomography) that measures blood flow and activity in the brain as part of a comprehensive psychiatric evaluation. SPECT provides valuable information about the brain, including areas with healthy blood flow and activity, areas that are overactive, and areas that are underactive.

Damage to the brain due to one or more concussions or traumatic brain injuries (TBI)—even mild head injuries that aren't diagnosed and don't cause a blackout—is a common finding in suicidal people. A 2018 study in JAMA1 found that the risk of suicide triples in the first six months following a TBI, and it remains elevated long after that. Compared to those who have not had a head injury, people who have experienced a TBI are at a 75% increased risk for suicide seven years after experiencing an injury.

Car accidents, falls, sports injuries, and other incidents can damage the brain in ways that increase the risk of depression, anxiety, anger, impulsivity, poor decision-making, and substance abuse. All of these issues have been associated with a greater incidence of suicidality.

SPECT scans reveal that temporal lobe abnormalities are common in suicidal people. The temporal lobes, located underneath your temples and below your eyes, are involved in mood stability and temper issues, among other functions2. Trouble in the temporal lobes is associated with unstable moods, anger issues, dark thoughts, and violence.

The prefrontal cortex3 (PFC) is involved in impulse control, planning, judgment, and thinking about the consequences of one's actions. When there is low activity in this brain region, which is a common finding on SPECT scans of people with suicidal thoughts and behaviors, it leads to problems such as impulsivity, poor decision-making, and impaired judgment.

According to data from our brain clinic, people with suicidal ideation tend to have head trauma, temporal lobe abnormalities, low activity in the prefrontal cortex, and/or an overactive anterior cingulate gyrus. While there is no simple answer or cure for suicide, protecting these affected brain regions can be an essential part of suicide prevention.