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The temptation of suicide: striatal gray matter, discounting of delayed rewards, and suicide attempts in late-life depression

  • A. Y. Dombrovski (a1), G. J. Siegle (a1), K. Szanto (a1), L. Clark (a2), C. F. Reynolds (a1) and H. Aizenstein (a1)
  • DOI:
  • Published online: 17 October 2011

Converging evidence implicates basal ganglia alterations in impulsivity and suicidal behavior. For example, D2/D3 agonists and subthalamic nucleus stimulation in Parkinson's disease (PD) trigger impulse control disorders and possibly suicidal behavior. Furthermore, suicidal behavior has been associated with structural basal ganglia abnormalities. Finally, low-lethality, unplanned suicide attempts are associated with increased discounting of delayed rewards, a behavior dependent upon the striatum. Thus, we tested whether, in late-life depression, changes in the basal ganglia were associated with suicide attempts and with increased delay discounting.


Fifty-two persons aged ⩾60 years underwent extensive clinical and cognitive characterization: 33 with major depression [13 suicide attempters (SA), 20 non-suicidal depressed elderly] and 19 non-depressed controls. Participants had high-resolution T1-weighted magnetization prepared rapid acquisition gradient–echo (MPRAGE) magnetic resonance imaging (MRI) scans. Basal ganglia gray matter voxel counts were estimated using atlas-based segmentation, with a highly deformable automated algorithm. Discounting of delayed rewards was assessed using the Monetary Choice Questionnaire (MCQ) and delay aversion with the Cambridge Gamble Task (CGT).


SA had lower putamen but not caudate or pallidum gray matter voxel counts, compared to the control groups. This difference persisted after accounting for substance use disorders and possible brain injury from suicide attempts. SA with lower putamen gray matter voxel counts displayed higher delay discounting but not delay aversion. Secondary analyses revealed that SA had lower voxel counts in associative and ventral but not sensorimotor striatum.


Our findings, although limited by small sample size and the case–control design, suggest that striatal lesions could contribute to suicidal behavior by increasing impulsivity.

Corresponding author
*Address for correspondence: A. Y. Dombrovski, M. D., Western Psychiatric Institute and Clinic, 100 N Bellefield Ave, Pittsburgh, PA 15213, USA. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

EP Ahearn , KR Jamison , DC Steffens , F Cassidy , JM Provenzale , A Lehman , RH Weisler , BJ Carroll , KR Krishnan (2001). MRI correlates of suicide attempt history in unipolar depression. Biological Psychiatry 50, 266270.

V Arango , MD Underwood , JJ Mann (1997). Postmortem findings in suicide victims. Implications for in vivo imaging studies. Annals of the New York Academy of Sciences 836, 269287.

AL Beautrais (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior 32, 19.

AT Beck , M Kovacs , A Weissman (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology 47, 343352.

RN Cardinal , DR Pennicott , CL Sugathapala , TW Robbins , BJ Everitt (2001). Impulsive choice induced in rats by lesions of the nucleus accumbens core. Science 292, 24992501.

M Chen , T Kanade , D Pomerleau , J Schneider (1999). 3-D deformable registration of medical images using a statistical atlas. In Medical Image Computing and Computer-Assisted Intervention – MICCAI'99 (ed. C. Taylor and A. Colchester ), pp. 621630. Springer: Berlin.

L Clark , AY Dombrovski , GJ Siegle , MA Butters , CL Shollenberger , BJ Sahakian , K Szanto (2011). Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychology and Aging 26, 321330.

Y Conwell , JM Lyness , P Duberstein , C Cox , L Seidlitz , A DiGiorgio , ED Caine (2000). Completed suicide among older patients in primary care practices: a controlled study. Journal of the American Geriatrics Society 48, 2329.

C Davatzikos , SM Resnick (2002). Degenerative age changes in white matter connectivity visualized in vivo using magnetic resonance imaging. Cerebral Cortex 12, 767771.

L Di Maio , F Squitieri , G Napolitano , G Campanella , JA Trofatter , PM Conneally (1993). Suicide risk in Huntington's disease. Journal of Medical Genetics 30, 293295.

AY Dombrovski , L Clark , GJ Siegle , MA Butters , N Ichikawa , BJ Sahakian , K Szanto (2010). Reward/punishment reversal learning in older suicide attempters. American Journal of Psychiatry 167, 699707.

AY Dombrovski , K Szanto , GJ Siegle , ML Wallace , SD Forman , B Sahakian , CF Reynolds 3rd, L Clark (2011). Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age. Biological Psychiatry 70, 138144.

LH Epstein , JB Richards , FG Saad , RA Paluch , JN Roemmich , C Lerman (2003). Comparison between two measures of delay discounting in smokers. Experimental and Clinical Psychopharmacology 11, 131138.

C Ernst , N Mechawar , G Turecki (2009). Suicide neurobiology. Progress in Neurobiology 89, 315333.

MF Folstein , SE Folstein , PR McHugh (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.

EM Foncke , PR Schuurman , JD Speelman (2006). Suicide after deep brain stimulation of the internal globus pallidus for dystonia. Neurology 66, 142143.

MJ Frank , J Samanta , AA Moustafa , SJ Sherman (2007 a). Hold your horses: impulsivity, deep brain stimulation, and medication in parkinsonism. Science 318, 13091312.

MJ Frank , A Scheres , SJ Sherman (2007 b). Understanding decision-making deficits in neurological conditions: insights from models of natural action selection. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 362, 16411654.

L Green , J Myerson , P Ostaszewski (1999). Discounting of delayed rewards across the life span: age differences in individual discounting functions. Behavioural Processes 46, 8996.

SN Haber , KS Kim , P Mailly , R Calzavara (2006). Reward-related cortical inputs define a large striatal region in primates that interface with associative cortical connections, providing a substrate for incentive-based learning. Journal of Neuroscience 26, 83688376.

SN Haber , B Knutson (2010). The reward circuit: linking primate anatomy and human imaging. Neuropsychopharmacology 35, 4–26.

TD Halbig , W Tse , PG Frisina , BR Baker , E Hollander , H Shapiro , M Tagliati , WC Koller , CW Olanow (2009). Subthalamic deep brain stimulation and impulse control in Parkinson's disease. European Journal of Neurology 16, 493497.

M Hamilton (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.

AR Hariri , SM Brown , DE Williamson , JD Flory , H de Wit , SB Manuck (2006). Preference for immediate over delayed rewards is associated with magnitude of ventral striatal activity. Journal of Neuroscience 26, 1321313217.

CR Housden , SS O'Sullivan , EM Joyce , AJ Lees , JP Roiser (2010). Intact reward learning but elevated delay discounting in Parkinson's disease patients with impulsive-compulsive spectrum behaviors. Neuropsychopharmacology 35, 21552164.

F Jollant , F Bellivier , M Leboyer , B Astruc , S Torres , R Verdier , D Castelnau , A Malafosse , P Courtet (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry 162, 304310.

F Jollant , NS Lawrence , V Giampietro , MJ Brammer , MA Fullana , D Drapier , P Courtet , ML Phillips (2008). Orbitofrontal cortex response to angry faces in men with histories of suicide attempts. American Journal of Psychiatry 165, 740748.

F Jollant , NS Lawrence , E Olie , O O'Daly , A Malafosse , P Courtet , ML Phillips (2010). Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. NeuroImage 51, 12751281.

JW Kable , PW Glimcher (2007). The neural correlates of subjective value during intertemporal choice. Nature Neuroscience 10, 16251633.

KN Kirby , NM Petry , WK Bickel (1999). Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls. Journal of Experimental Psychology: General 128, 7887.

S Luo , G Ainslie , L Giragosian , JR Monterosso (2009). Behavioral and neural evidence of incentive bias for immediate rewards relative to preference-matched delayed rewards. Journal of Neuroscience 29, 1482014827.

D Martinez , M Slifstein , A Broft , O Mawlawi , DR Hwang , Y Huang , T Cooper , L Kegeles , E Zarahn , A Abi-Dargham , SN Haber , M Laruelle (2003). Imaging human mesolimbic dopamine transmission with positron emission tomography. Part II: Amphetamine-induced dopamine release in the functional subdivisions of the striatum. Journal of Cerebral Blood Flow and Metabolism 23, 285300.

SM McClure , DI Laibson , G Loewenstein , JD Cohen (2004). Separate neural systems value immediate and delayed monetary rewards. Science 306, 503507.

A McGirr , M Alda , M Seguin , S Cabot , A Lesage , G Turecki (2009). Familial aggregation of suicide explained by cluster B traits: a three-group family study of suicide controlling for major depressive disorder. American Journal of Psychiatry 166, 11241134.

FA Middleton , PL Strick (2000). Basal ganglia output and cognition: evidence from anatomical, behavioral, and clinical studies. Brain and Cognition 42, 183200.

MD Miller , CF Paradis , PR Houck , S Mazumdar , JA Stack , AH Rifai , B Mulsant , CF Reynolds 3rd (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research 41, 237248.

ES Monkul , JP Hatch , MA Nicoletti , S Spence , P Brambilla , AL Lacerda , RB Sassi , AG Mallinger , MS Keshavan , JC Soares (2007). Fronto-limbic brain structures in suicidal and non-suicidal female patients with major depressive disorder. Molecular Psychiatry 12, 360366.

M Muranishi , H Inokawa , H Yamada , Y Ueda , N Matsumoto , M Nakagawa , M Kimura (2011). Inactivation of the putamen selectively impairs reward history-based action selection. Experimental Brain Research 209, 235246.

AM Owen , AC Roberts , JR Hodges , BA Summers , CE Polkey , TW Robbins (1993). Contrasting mechanisms of impaired attentional set-shifting in patients with frontal lobe damage or Parkinson's disease. Brain 116, 11591175.

A Rangel , C Camerer , PR Montague (2008). A framework for studying the neurobiology of value-based decision making. Nature Reviews Neuroscience 9, 545556.

N Raz , U Lindenberger , KM Rodrigue , KM Kennedy , D Head , A Williamson , C Dahle , D Gerstorf , JD Acker (2005). Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cerebral Cortex 15, 16761689.

N Raz , KM Rodrigue (2006). Differential aging of the brain: patterns, cognitive correlates and modifiers. Neuroscience and Biobehavioral Reviews 30, 730748.

C Rosano , HJ Aizenstein , S Studenski , AB Newman (2007). A regions-of-interest volumetric analysis of mobility limitations in community-dwelling older adults. Journals of Geronology Series A: Biological Sciences and Medical Sciences 62, 10481055.

FT Russchen , I Bakst , DG Amaral , JL Price (1985). The amygdalostriatal projections in the monkey. An anterograde tracing study. Brain Research 329, 241257.

SM Smith (2002). Fast robust automated brain extraction. Human Brain Mapping 17, 143155.

EN Stenager , L Wermuth , E Stenager , J Boldsen (1994). Suicide in patients with Parkinson's disease. An epidemiological study. Acta Psychiatrica Scandinavica 90, 7072.

CJ Todes , AJ Lees (1985). The pre-morbid personality of patients with Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry 48, 97–100.

N Tzourio-Mazoyer , B Landeau , D Papathanassiou , F Crivello , O Etard , N Delcroix , B Mazoyer , M Joliot (2002). Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage 15, 273289.

C van Heeringen , S Bijttebier , K Godfrin (2011). Suicidal brains: a review of functional and structural brain studies in association with suicidal behaviour. Neuroscience and Biobehavioral Reviews 35, 688698.

FJ Vang , E Ryding , L Träskman-Bendz , D van Westen , MB Lindström (2010). Size of basal ganglia in suicide attempters, and its association with temperament and serotonin transporter density. Psychiatry Research: Neuroimaging 183, 177179.

V Voon , P Krack , AE Lang , AM Lozano , K Dujardin , M Schupbach , J D'Ambrosia , S Thobois , F Tamma , J Herzog , JD Speelman , J Samanta , C Kubu , H Rossignol , YY Poon , JA Saint-Cyr , C Ardouin , E Moro (2008). A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Brain 131, 27202728.

V Voon , B Reynolds , C Brezing , C Gallea , M Skaljic , V Ekanayake , H Fernandez , MN Potenza , RJ Dolan , M Hallett (2010). Impulsive choice and response in dopamine agonist-related impulse control behaviors. Psychopharmacology (Berlin) 207, 645659.

V Voon , T Thomsen , JM Miyasaki , M de Souza , A Shafro , SH Fox , S Duff-Canning , AE Lang , M Zurowski (2007). Factors associated with dopaminergic drug-related pathological gambling in Parkinson disease. Archives of Neurology 64, 212216.

M Waern , BS Runeson , P Allebeck , J Beskow , E Rubenowitz , I Skoog , K Wilhelmsson (2002). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry 159, 450455.

G Wagner , K Koch , C Schachtzabel , CC Schultz , H Sauer , RG Schlösser (2011). Structural brain alterations in patients with major depressive disorder and high risk for suicide: evidence for a distinct neurobiological entity? NeuroImage 54, 16071614.

D Weintraub , J Koester , MN Potenza , AD Siderowf , M Stacy , V Voon , J Whetteckey , GR Wunderlich , AE Lang (2010). Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Archives of Neurology 67, 589595.

D Weintraub , AD Siderowf , MN Potenza , J Goveas , KH Morales , JE Duda , PJ Moberg , MB Stern (2006). Association of dopamine agonist use with impulse control disorders in Parkinson disease. Archives of Neurology 63, 969973.

RP Woods , ST Grafton , JD Watson , NL Sicotte , JC Mazziotta (1998). Automated image registration: II. Intersubject validation of linear and nonlinear models. Journal of Computer Assisted Tomography 22, 153165.

M Wu , O Carmichael , P Lopez-Garcia , CS Carter , HJ Aizenstein (2006). Quantitative comparison of AIR, SPM, and the fully deformable model for atlas-based segmentation of functional and structural MR images. Human Brain Mapping 27, 747754.

TS Yoo (ed.) (2004). Insight into Images: Principles and Practice for Segmentation, Registration, and Image Analysis. AK Peters Ltd: Wellesey, MA.

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