Altitude, depression and suicide

Research links lower oxygen levels at high elevation with a higher risk of depression and suicide.

The mountains attract people who want a change, people who think leaving sea level behind will improve their lives.

But though the scenery may boost you, there’s evidence that going higher could simultaneously bring down your mood.

That’s the conclusion of researchers at the University of Utah who think there’s a link between high altitudes and depression. It’s the result of less oxygen and its subsequent ill effect on brain chemistry, and the effect may also hinder the usefulness of common drug treatments.

There is “epidemiological evidence that increases in the altitude of residence are linked to the increased risk of depression and suicide,” said Drs. Perry Renshaw, Douglas Kondo and Brent Kious in a study published last year in the Harvard Review of Psychiatry.

In their paper the doctors argue that “hyperbolic hypoxia” — that’s what the specialists called a lack of oxygen caused by low air pressure — “could promote suicide and depression by altering serotonin metabolism and brain bioenergetics.”

In an email, Renshaw said he and his colleagues “would probably say that hypoxia caused by any conditions (COPD, asthma, sleep apnea, anemia, thin air due to altitude) is likely to lead to increased rates [and] severity of depression, anxiety and suicide.

“Individuals who come from families with increased rates of low serotonin disorders (depression, anxiety, migraine, alcohol abuse) are likely to feel worse at higher altitude,” he said.

Serotonin is a hormone made by the brain that acts as a neurotransmitter. Low serotonin is generally recognized as a cause of depression, and treatments for depression focus on increasing serotonin in the brain. Among treatments are drugs called selective serotonin reuptake inhibitors. Though the exact mechanism of how SSRIs work isn’t known, what is known is that keeping serotonin levels from falling too low is essential.

Dr. Cheryl Collins, a psychiatrist in private practice in Jackson, said serotonin “regulates mood,” and without a healthy level of it “your mood is going to go down.”

“It’s a very interesting idea,” Collins said of the potential of a link between low oxygen and serotonin, and the related idea that low oxygen might also interfere with the efficiency of SSRI drugs such as Prozac, Celexa and Lexapro. “There is apparently something about low oxygen concentration above 3,000 feet that may cause people to have lower serotonin.”

The question is of special importance in Wyoming, which — for whatever combination of reasons — a recent study concluded is the 11th most depressed state in the country.

At depression’s extreme manifestation, suicide, the rate in Wyoming is fourth highest in the country and has been rising in recent years: from 17 per 100,000 in 2004 to 24 per 100,000 in 2016. The national rate is 14 per 100,000. Joining Wyoming in the top five in the country were Utah, Montana and New Mexico. Suicide rates increase sharply at between 2,000 and 3,000 feet, the research found.

Depression is usually regarded as the most widespread psychological affliction in the United States.

“Depression is one of the most common mental disorders there is,” Collins said. “Anxiety and depression are sort of neck and neck for being pretty ubiquitous.”

As society has come to know in recent decades, depression is more than feeling down for a while.

People with depression feel sad, have low energy, exhibit lack of interest and have trouble concentrating. They may feel guilty for no apparent reason or that they are worthless. They often lose their appetite and either have trouble sleeping or find themselves fighting to stay awake. Many people have thoughts of suicide pop into their heads and have trouble stopping them.

For people experiencing depression — and especially those receiving no treatment — the anguish “can be quite extreme,” Collins said.

Though about 15 percent of people are what are called “nonresponders” — seemingly immune to any intervention — Collins said about 85 percent respond to one of three treatments that are known to have some benefit, or, more likely, to all three of the treatments.

“In most major studies, medication, talk therapy and exercise were better than any one of those alone for depression,” Collins said. “The response to those treatments is pretty good.”

People who are treated feel their mood lift, and professionals can usually see what their patients are feeling.

“I notice people are feeling better,” Collins said. They start to say, ‘[I]feel more like myself’ or ‘I’m enjoying things like I used to’ or ‘My thinking isn’t as fuzzy.’”

The effects of high altitude and low oxygen on depression and depression drugs “could be a big problem” for everyone involved, Collins said. But she said it’s just one factor in dealing with a condition in which there’s a lot of balancing to find the right program for each person.

Some people might still respond to drug treatment at common doses; others might require more or need a different drug.

“There are medications that work on other neurotransmitters,” Collins said, “and if what we start with does not work then we would try other medicines to see if we get a different response.”

Renshaw said the drug sertraline, brand name Zoloft, was found in animal studies to be “the most effective SSRI antidepressant at altitude.”

It’s important to note that not everybody who moves to high altitude has low serotonin, and Renshaw acknowledged that the complexity of brain chemistry makes generalization difficult. He mentioned dopamine, another neurotransmitter associated with good feelings that is boosted by exercise and other activities, as an additional factor to consider.

“Increased brain dopamine levels (which frequently occur in going to the mountains) will make whatever one is doing more fun and enjoyable,” he said.

To reach the National Suicide Prevention Lifeline, call 800-273-TALK (8255). You can also text a crisis counselor by messaging 741741.

Contact Mark Huffman at 732-5907 or

Mark Huffman edits copy and occasionally writes some, too. He's been a journalist since newspapers had typewriters and darkrooms.

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