Yes, I am. Let me introduce myself. I'm Zul Merali, the president and CEO of the Royal's Institute of Mental Health Research in Ottawa. I'm also the founding scientific director of the Canadian Depression Research and Intervention Network.
As you know, over 4,000 Canadians commit suicide every year. This is almost like a couple of planeloads crashing with no survivors every month of the year. You can imagine that if that were the situation for any other condition, what a public outcry there would be.
Suicide is one of the seven leading causes of death in Canada, and we have to take a public health approach. We also need to better understand the underlying causes or underpinnings of suicide or suicidal acts.
The biology of suicidal ideation and suicidal acts remains unknown, and this is particularly important because we need to understand what goes awry in the brain and why some people are susceptible while others are resilient under the same set of circumstances.
My objective here today is to call for research. We know that getting into care is not necessarily enough. About half the many people who are in care already will still go through suicidal acts and sometimes succeed in taking their own lives. The vast majority of the individuals who have experienced major trauma or are depressed do not necessarily kill themselves. We do not have a robust way of predicting who will attempt and who will complete suicide.
At the Royal, we are making a particular effort to understand suicide a lot better. I'll tell you a little about our approaches. One of them is that we have created a brain imaging centre in partnership with philanthropists, the Department of National Defence, universities, and the Legion, etc. This was a public effort to come together to bring in tools that can help us make the invisible visible. We need to look inside the brain because that's where the suicidal ideation and the will to commit suicide reside.
To make a point, this slide shows that the brains of people who have post-traumatic stress disorder look very different. They light up like a Christmas tree, as you can see here, using specific ligands in the brain as compared to the other two brains that are matched controls. Here's a demonstration not only of how imaging can be a very strong diagnostic tool, but also very powerful in understanding what some of the underpinnings of those conditions might be.
I'm happy to share with you some information that we have of late. As you know the development of anti-depressants has been rather slow, but of late we have had significant advances. I'm presenting data here that shows you that if you treat people with a certain new class of drugs—although the drug itself is not new, the use of this drug is very new, involving the use of an old anaesthetic at a very low dose, acting as a very powerful anti-depressant—it can alleviate symptoms of depression within hours or days, as compared to weeks or months with traditional anti-depressants. What's even more exciting with this line of treatment is that the suicidal ideation seems to be affected even more powerfully. It goes down much faster than the anti-depressant action, and even those individuals who do not respond with an anti-depressant action will have their suicidal ideation plummet within hours. This is really very exciting, because we can now intervene very quickly and very effectively in alleviating the suicidal ideation.
What's even more interesting are the green bars in this graph, which I would like you to focus on, showing people expressing very little suicidal ideation. The blue and the red are showing high to moderate amount of suicidal ideation. As you can see, almost 90% become free of suicidal ideation within two weeks of ketamine treatment.
This is very exciting, but what's even more exciting is the fact that it gives us an opportunity to disassociate the depressive symptoms in general, on the one hand, from suicidal ideation on the other. We want to be able to image this in the brain to see if we can identify where in the brain suicidal ideation resides. In other words, what are the brain's circuits that are responsible for suicidal ideation? If we can understand that better, I think we can then begin to target treatment much more effectively in those cases.
The action plan we have is that we want to focus on depression, because very often depression is associated with suicidal ideation. We want to also focus on post-traumatic stress disorder, which is highly correlated with suicidal acts.
We have recently created a chair in military and veterans mental health research. We have created a chair in stress and trauma research. I am very proud to say that the individual studying the use of the tool I showed you earlier, which showed you very clearly the brain of someone with PTSD, we have recruited from Yale in New York. He just started last week at our organization.
We are partnered with the National Network of Depression Centers, in the U.S., and with the European Alliance Against Depression, so that we are in tune with what's going on globally. Also, we are partnering with the Mental Health Commission of Canada to test a four-pronged approach to reducing suicidal acts in Canada.
There is a strong need to create a centre of excellence that is focused on military and non-military trauma and related outcomes, including suicidal acts.
With that, I'd say thank you for giving me this opportunity to share our excitement and our concerns. I'm happy to take any questions.