What’s really driving suicide?

This is a subject no-one wants to talk about yet everyone knows someone who has, or has attempted suicide. It is actually the leading cause of death in men aged 25 to 29, and in women aged 30 to 34, and is the 11th leading cause of death overall, killing close to 5,000 people a year – double road traffic accidents. Knowing something about the driving factors can literally help save someone’s life. Obviously, the risk is linked to feeling hopeless, deep depression and also aggressive tendencies. (Men more than women show depression as increased aggression.) Yet, there are other factors that may also increase risk.

‘Antidepressants increase risk of suicide, violence and homicide’ reads the headline of an article in the British Medical Journal last year. Two thirds of women and half of men who commit suicide started taking psychiatric medication within the year. With anti-depressant prescriptions soaring (64.7 million last year) this is a cause for concern. While it is now well established that anti-depressant drugs increase suicidal tendencies versus placebo, this is one of those chicken or egg situations since people who are acutely depressed are more likely to seek and be given medication. In the 18 to 24 age group the risk of suicide is substantially higher within the first two months of taking anti-depressants. According to a study published in the Journal of the American Medical Association [1] non-fatal suicidal behaviour is four times more likely to occur within 10 days of starting medication, and three times more likely within 10 to 29 days, compared to after 90 days. So, it is really important to keep an eye on someone who has recently started medication and make sure they report any signs of increased inner agitation to their doctor because this may indicate an adverse reaction to medication.

Suicidality is also strongly linked to antiepileptic drugs. In America the FDA has a black box warning on these drugs. In some countries antiepileptic drugs are widely prescribed to those diagnosed with depression.Some of these drugs are licensed for the treatment of bipolar disorder, which is increasingly being diagnosed, often spuriously. In a study in the New England Journal of Medicine last year these drugs were linked with an increased risk of suicide-related events among patients with depression.[2]

Another known risk factor is having too low a cholesterol level or a lack of omega 3 fats. The dry weight of the brain is 60% fat,including substantial amounts of cholesterol. Taking anti-cholesterol medication, especially when your cholesterol level isn’t high, or eating a diet completely devoid of fats, can lead to too low cholesterol (below 4.27 mmol/l). In one study men with a cholesterol below this were seven times more likely to die prematurely from unnatural causes, including suicide and accidents. [3]. A low cholesterol level is also associated with increased risk for depression and violent behaviour.

A lack of omega 3 fats, especially DHA, is a good predictor of suicide risk among depressed people. This really emphasizes the need to give people who are depressed more omega 3s by eating oily fish and/or taking supplements. I recommend around 500mg of combined EPA/DHA a day which you’ll get in a good 1,000mg omega 3 rich fish oil.

While the peak age range for suicide is 45 to 54, and often follows extreme loss such as the break up of a relationship, losing one’s job, or financial ruin, among younger people there’s a very strong link with eating disorders in younger people. In one follow up of 6,000 anorexic patients over 30 years, 265 died, of which 37% committed suicide! [4] If you know someone with eating disorders it’s really important that they find help. A good support organisation is b-eat.co.uk.

Suicidal thoughts are an extreme symptom of depression and there are many ways to boost mood naturally, as well as getting good psychotherapy. My book, The Feel Good Factor, gives ten proven ways to boost mood, including natural mood boosters such as 5-HTP, which is the form of tryptophan from which the brain makes serotonin, omega 3 fats, vitamin D, chromium, B vitamins, and a low GL diet. None of these have any associated risks. I wish they were the first port of call of psychiatrists, not the last.


[1] Jick H, Kaye JA, Jick SS, JAMA 2004,292(3):338-43

[2] Arana A et al., NEngl JMed 2010, 363(6):542-51

[3] Boscarino et al., J Psychiatr Res 2009, 43 (9):848-54.

[4] Papadoulos, BritJPsych (2009) 194, 10-17.