Background: This presentation will provide an overview of the physiological factors that contribute to the increased risk of suicide in patients with eating disorders. Topics discussed will include multiple biological risk factors, including antidepressant medications and nutritional deficiencies in essential nutrients including essential fatty acids, lithium, and vitamin B12.
- Incidence of suicide in patients with eating disorders
- Identifying possible risk factors for suicide
- Overview of treatment of eating disorders
- Overview of pharmacological treatments
- Malnutrition as a risk factor
- Research analyzing essential fatty acids deficiency in the role of eating disorders
- Effects on brain chemistry such as cognition, mood, and behavior
- Research supporting omega 3 fatty acid supplementation in decreasing suicide risk
- Antidepressant medications
- FDA black box warning of increased suicidal ideation
- Augmentation strategies
- Anti-suicidal properties of lithium
- Review of current research using lithium as treatment for Bipolar Disorder
- Review of research relating lithium in food and water supply with suicide risk
There is a high incidence of suicide in patients with eating disorders, although there is an inconsistent understanding of the risk factors involved. Harris and Barraclough (1997) reported that the suicide mortality rate among both anorexics and bulimics to be 23 times higher than that of the general population, placing the rate of suicide among eating disorder patients among the highest of all psychiatric illnesses. It is thought that due to the restrictive eating behaviors and limited fat intake for extended periods of time commonly seen in patients with eating disorders, malnutrition may increase the risk for suicidal behavior. Malnutrition has profound effects on brain chemistry, reflecting changes in cognition, mood, and behavior.
In a recent study published in the Journal of Clinical Psychiatry, U.S. veterans that were found to have low levels of omega 3 fatty acids in their blood were 62% more likely to commit suicide. Studies analyzing brains of suicide completers show that there is a significant decrease in fat content, implicating omega-3 fatty acids deficiency as a risk factor for suicide. There is a growing body of research describing a clear association between essential fatty acids deficiency and suicide.
Multiple research studies have also shown that lithium has anti-suicidal properties. Although high doses of lithium may be used as a treatment for Bipolar Disorder, research has shown that low doses of lithium in the soil and water supply have also been correlated with suicidal risk.
Antidepressant medications are commonly prescribed for patients with eating disorders, despite FDA black box warnings of their potential risk of suicidal ideation. The research on suicidal behavior with antidepressant medications will be explored and discussed in context of eating disorders in adolescents and adults.
This presentation will explore the complex, multifaceted issues of increased suicide rates in patients with eating disorders. It will focus on the biological factors including antidepressant medications that increase suicide risk and explore the components of malnutrition contributing to the increased risk of suicide in adolescents and adults with eating disorders.
James Greenblatt, M.D., a dually certified adult and child psychiatrist, is the Medical Director of Eating Disorder Services at Walden Behavioral Care in Waltham, MA. His books, Answers to Anorexia and The Breakthrough Depression Solution, draw on his many years of experience and expertise in integrative medicine. He is also the Founder and Medical Director of a private integrative psychiatric practice, Comprehensive Psychiatric Resources, Inc. and serves as an Assistant Clinical Professor at Tufts Medical School.