Suicide has been described as "a permanent solution to a temporary problem" (Buchwald, 2006), reflecting the view that suicide is the result of poor decision making. The strongest biological finding in suicide research is the association with reduced serotonergic neurotransmission, particularly within the ventromedial prefrontal cortex (VMPFC) (Mann, 2003). This deficit in serotonergic neurotransmission is thought to impair cognition, predisposing patients to become more impulsive, rigid in their thinking, and poorer decision makers. Decisions during depressed states are tainted by negative affect and distorted negative cognitions (Martin-Soelch, 2009). However, suicide has been associated with cognitive impairments that go beyond those of depression. Asymptomatic patients with a history of suicide attempts exhibit significant cognitive deficits suggestive of generalized prefrontal cortex (PFC) dysfunction (Raust et al, 2007; Westheide et al, 2008), and corollary disruptions in risk assessment (Martino et al, 2010). Poor inhibition is found in suicide attempters when compared with patients with only suicidal ideation (Burton et al, 2011), and greater cognitive impairments are found in depressed patients with suicidal ideation compared to those without it (Dombrovski et al, 2010). It is possible that cognitive deficits may be specific to suicidal behavior rather than to any comorbid or specific psychiatric diagnosis because this observation holds true for suicidal patients with depression, bipolar disorder, and even temporal lobe epilepsy. However, most of these studies were performed in symptom-free patients, often months or years after the presence of suicidal ideation or behavior. In a previous report (Cáceda et al, 2014) we demonstrated that inability to delay gratification (choosing smaller immediate rewards over larger delayed rewards) is shared by both recent suicide attempters and depressed patients with suicidal ideation. On a follow up assessment, 5-10 days after the suicide attempt, reduction of suicidal ideation and intent was correlated with decreased symptoms of depression and recovery of delayed gratification impairments (Cáceda et al, 2014). These data are congruent with the hypothesis that stressful situations in combination with a biological and psychological predisposition may create a critical climate of overwhelming psychological pain in an individual who chooses an impulsive escapist strategy to terminate his/her own life discounting all future outcomes (Vohs et al, 2002). However, the underlying neural mechanisms remain unknown and therefore not amenable to therapeutic interventions.