Comprehensive view of suicide: A neuro-immune-endocrine approach

Figure 1 Changes caused by exposure to early life adversity or chronic stress. A: Epigenetic changes in hypothalamic pituitary adrenal axis functioning and the immune system caused by exposure to early life adversity (ELA); B: Chronic inflammation caused by exposure to ELA or chronic stress causes decreased dopamine production through the inhibition of tetrahydrobiopterin, as well as decreased serotonin production caused by the activation of indoleamine 2,3-dioxygenase. Moreover, chronic inflammation induces neuroinflammation, which increases the risk of suicide. HPA: Hypothalamic pituitary adrenal; IDO: Indoleamine 2,3-dioxygenase. Created in BioRender (Supplementary material).