Could feeling depressed be more about altitude than attitude? According to a new review of a dozen studies on suicide and the elevation at which victims lived, the answer is yes. While you don’t have to pack your bags and move to sea level to reduce your risk for depression, people who are currently battling depression and who live in higher elevation states should be very conscious of the statistical link between living at high elevations and suicide.

Study findings: We’ve known for some time that the highest rates of suicide in the US are in many of our most mountainous state—from the top down, Wyoming, Alaska, Montana, New Mexico, Utah, Colorado, Idaho and Nevada, states with some in the highest elevations in the country.

And the lowest suicide rates are in states where elevations are very low—starting from the bottom up, that’s the District of Columbia, New  Jersey, New York, Massachusetts and Rhode Island.

University of Utah researchers who reviewed the studies were able to connect the dots and show that there’s an “elevation threshold”— suicide rates start to rise at altitudes between 2,000 and 3,000 feet. Key stats: The annual suicide rate per 100,000 people is 5.7 at “low altitudes” defined by the study as below 3,200 feet, 11.9 at the “middle altitude” range of  3,200 feet to 6,500 feet and 17.7 at a high altitude of 6,500 feet or higher.

Even when factors such as poverty, isolation, lower income and gun ownership (which makes suicide less difficult) were taken into account, the suicide rate is still higher at higher altitudes. In fact, living at a high altitude was more closely linked to suicide than was gun ownership. With the US suicide rate steadily rising for the last 30 years, understanding every risk factor can help reduce it.

Why This Kind of High Makes You Low

One possible explanation for the higher suicide rates revolves around serotonin, the chemical messenger in the brain that enhances mood—low levels have been linked to depression and suicide. Serotonin production is reduced by low levels of oxygen in the body, which is exactly what happens to people at high altitudes.

Another theory is that the low oxygen in the body at altitude (the medical term is hypobaric hypoxemia) causes a reduction in the brain chemicals ATP and creatine, which are needed for proper nerve cell function and brain energy. Low brain energy can lead to depression, and severe depression is the major cause of suicide. If future studies confirm the findings of this study, taking medication to increase serotonin or creatine both could help you better manage depression when living at a high elevation.

It probably doesn’t make sense for most people with depression to disrupt their lives by doing something drastic like moving (or avoiding a trip to a high elevation) to avoid suicide risk. Brent Kious, MD, PhD, the study’s lead researcher, said he would, though, encourage people with a history of depression or suicidal ideation to be on the lookout for increased symptoms of depression if they do move to a higher elevation, and to take steps to minimize the risk that their depression will get worse…

by exercising, maintaining a healthy diet, avoiding substances of abuse, and, continuing medications as recommended by your physician.

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