My classmate from university, C passed away on 16
January at age 39. He had jumped to his death, apparently after battling
depression for the past two years. His father witnessed the incident.
I am very saddened by his choice – an irreversible
choice – when one ultimately takes one’s own life. Perhaps it might be a good
choice for him – if he had been miserable all these while. Perhaps, it might be a good
choice for those around him – if they had been helpless and had seen him struggle
through each day.
One thing’s for sure, I will never see or hear from C
again. I dedicate this to him:
Last night
as I lay on my bed,
I wondered
what had made you done so;
Last night
as I lay on my bed,
I can’t bear
to see you go…………….
As a pharmacist, he probably would have known and could
gain access to antidepressants if he ever needed them. I don’t know if he took any
medication. In 2003, a well publicized US FDA warning on the use of
antidepressants – that is it increases the risks of suicidal behaviours – might
have led to a reduced use of antidepressants for the past 10 years1.
The same report indicated a simultaneous significant rise in suicide attempts.
Indeed the search for a ‘cure’ to prevent suicide by the usual pharmacological
experimental models would be very difficult2
-
Suicide death and suicide attempt
are rare outcomes, very large sample sizes and long observation periods are
required to detect effects.
-
It would not be ethical to have a
placebo arm in such high-risk studies.
Of interest is that polyunsaturated fatty acids may play
a role in reducing suicidal behavior3. In recent years, substantial evidence
has linked a dietary deficiency in essential long-chain omega-3 (LCn-3) fatty acids, eicosapenaenoic acid
(EPA) and docosahexaenoic acid (DHA), to the occurrences of major depressive
disorder, bipolar disorder, schizophrenia, attention deficit hyperactivity
disorder (ADHD), and anxiety disorders. The evidence suggests that EPA+DHA
doses in the range of 1–4 g/d are potentially efficacous and are safe and
well-tolerated in pediatric, adolescent, and adult psychiatric patients. In
particular, the EPA+DHA in a 2:1 EPA to DHA ratio are efficacious for the
treatment of mood symptoms and a larger ratio of EPA to DHA may be more
efficacious for treating depressive symptoms as well as ADHD symptoms. To
minimize the gastrointestinal adverse events (nausea, diarrhea,
gastroesophageal reflux, eructation) associated with LCn-3 fatty acids, patients should be
instructed to take their pills with meals.
Now, is it that simple?
Could eating more fish be able to safe C? Could he had led happier lives by
popping omega-3 fatty acid supplements?
- Lu CY et al. Changes in antidepressant use by young people and
suicidal behavior after FDA warnings and media coverage:
quasi-experimental study. BMJ. 2014 Jun 18;348:g3596.
- Mann JJ, Currier D. Medication in Suicide Prevention. Insights from Neurobiology of Suicidal
Behavior.The Neurobiological Basis of Suicide.
- McNamara RK, Strawn JR. Role of Long-Chain Omega-3 Fatty Acids in
Psychiatric Practice. PharmaNutrition. 2013 Apr;1(2):41-49.
