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In the past few weeks one reality television star and one former professional athlete committed suicide. Although we know that most of those who commit suicide are not famous and receive little to no media attention.
Based on 2007 figures, the CDC has found that approximately 94 people commit suicide every day. For every suicide death another 25 people attempt suicide. In fact, there are twice as many suicide deaths per week in the US than homicide deaths.
Despite being the 11th leading cause of death, suicide is still largely a mystery to professionals as well as families. Whenever a suicide occurs people are left asking, why? Why did the person choose self-harm? Were they depressed? Were they in trouble? What more could I have done to help them? The answers are not always clear.
But there are certain risk factors that make an individual more likely to commit suicide:
- Feelings of hopelessness
- Impulsive/aggressive tendencies
- Social isolation
- Familial/Financial/Social Loss
Depression, psychiatric illness, and/or a substance abuse disorder, play a role in greater than 90% of suicides. Yet, we have very limited, unscientific screening tools for predicting or preventing suicide.
Antidepressants may reduce symptoms of depression (one of the risk factors associated with suicide) for some, but nearly 70% of patients on these medications experience residual symptoms. In fact, the most worrisome symptom, increased risk of suicide, has prompted the FDA to put warnings on all antidepressants.
Instead of solely looking at psychological symptoms as a barometer of suicide risk, it might help to look at populations more prone to suicide attempts.
As the former Medical Director of an inpatient eating disorder treatment center, I witnessed firsthand far too many completed and attempted suicides. Of all psychiatric illnesses, patients with eating disorders have among the highest mortality rate. Patients with anorexia nervosa are at high risk for suicide-possibly more so than patients with depression or any other psychiatric disorder!
Why are patients with eating disorders more susceptible to suicide than other populations? The answer may reveal some insightful information into the biological changes that might lead a person to not only contemplate but complete suicide.
The common denominator shared by all patients with anorexia nervosa is malnutrition. In my book, Answers to Anorexia, I use the term "malorexia" to describe the profound state of malnutrition in patients with eating disorders. Malnutrition may be the underlying biological mechanism behind the unimaginable act of suicide.
One class of nutrients that patients with anorexia avoid for extended periods is fat. Patients with anorexia have a pervasive fear of fat and avoid any and all kinds of fat.
How does fat avoidance affect mental health? The brain is a cholesterol rich organ with fat contributing to 60% of its dry weight. As a fat-rich organ, optimal brain function relies on adequate amounts of cholesterol and essential omega-3 fatty acids, including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Many research studies attest to this fact: Over the past 20 years, there have been several studies concluding that low omega-3 fatty acid levels are associated with depression, anxiety, and more recently suicide.
In a previous blog I discussed the relationship between low cholesterol and depressed mood and suicide.
Just this past month, the Journal of Clinical Psychiatry published "Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison." The study compared the medical records of 800 U.S. servicemen and women who committed suicide between 2002 and 2008, with the records of 800 service personnel-matched for age, gender and rank-who had no history of suicide attempts. The study found that low levels of the omega-3 fatty acid DHA was a strong predictor of suicide among military personnel.
Specifically, servicemen with the lowest range of DHA levels were 62% more likely to have completed suicide than those with higher levels of DHA. It should be noted that all military personnel in the study generally had low levels of DHA.
Another study which examined young Chinese males who attempted suicide found, once again, that low levels of omega-3 fatty acids were a risk factor for suicide attempt.
It's clear that omega-3 fatty acids and other fats such as cholesterol are important for brain function. According to The Franklin Institute:
"By modifying natural fats, we have altered the basic building blocks of the human brain-weakening cerebral architecture. And, like unstable buildings that come apart in an earthquake or storm, poorly structured human brains are failing to cope with the mounting stress of modern life."
In my experience essential fatty acid supplementation is critical for many struggling with depression and suicidal thoughts. I do use caution with high dose omega-3 supplementation as I've seen this create significant imbalances in other essential fatty acids.
Depression is a complex illness with many physical and psychological factors contributing to symptom patterns. I urge my colleagues to look for these underlying factors before indiscriminate use of medications. It is hard to ignore the many roles that "healthy" fats play in optimal brain function.
We must continue to examine the role of EFAs and cholesterol as factors in attempted and completed suicide. Understanding the role of fats and brain function has profound implications for suicide prevention.
