Reducing suicide risks by taking a EPA and DHA

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?

1. 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.
2. Mann JJ, Currier D. Medication in Suicide Prevention. Insights from Neurobiology of Suicidal Behavior.The Neurobiological Basis of Suicide. Boca Raton (FL): CRC Press; 2012. Chapter 21.
3. McNamara RK, Strawn JR. Role of Long-Chain Omega-3 Fatty Acids in Psychiatric Practice. PharmaNutrition. 2013 Apr;1(2):41-49.