Serum β-endorphin levels are associated with addiction to suicidal behavior: A pilot study

Eur Neuropsychopharmacol. 2020 Nov;40:38-51. doi: 10.1016/j.euroneuro.2020.07.010. Epub 2020 Aug 24.


The literature provides partial support for the hypothesis that some suicide attempters develop a behavioral addiction to suicidal behavior (SB). We hypothesized that major suicide repeaters (MR) (≥5 lifetime suicide attempts) are addicted to suicide attempts as measured by modified DSM-IV criteria for substance dependence. In this cross-sectional study with 13 psychiatric controls (PC), 55 non-major suicide attempters (NMR), and 9 MR we found that MR are characterized by emotional abuse and neglect, as well as higher scores on the Personality and Life Event scale (short version). The levels of 8 AM serum ACTH, cortisol and β-endorphin were elevated in all three groups. Serum β-endorphin (pg/mL) was particularly high in PC diagnosed with schizophrenia 220.34 (±56.30). The level of 8 AM serum β-endorphin rose with increased numbers of criteria met for addiction to SB from 130.31 (±88.16) (≥ 3 criteria met for addiction to SB) to 174.84 (±114.93) (≥ 6 criteria met for addiction to SB) whereas serum ACTH and cortisol did not change. SB addicts (≥ 6 criteria) displayed higher serum β-endorphin concentrations than non-addicts (174.84 ± 114.93 vs. 116.93 ± 61.70, FET p = 0.09). The present study brings some support to the addictive hypothesis of SB. Our results delineate β-endorphin as a promising biomarker of SB addiction, and offer a good basis for future studies that test whether buprenorphine can be used to prevent repetitive suicide attempts, non-suicidal-self-injury (NSSI), and the development of an addiction to SB.

Keywords: ACTH; Addiction; Beta-endorphin; Cortisol; Suicidal behavior.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adult Survivors of Child Abuse / psychology*
  • Behavior, Addictive / blood*
  • Behavior, Addictive / psychology*
  • Biomarkers / blood
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Suicidal Ideation*
  • Suicide, Attempted / psychology*
  • Young Adult
  • beta-Endorphin / blood*


  • Biomarkers
  • beta-Endorphin