Mental health is really “whole person health”. This is important. Suicide and depression could be attributed to abuse or other psychological factors; but there could also be physiological factors at play that happen to have mental manifestations. Poverty and other social factors further complicate the situation. Let’s get rid of the stigma around mental health disorders. Mental health disorders are multifactorial, in part a biological problem, and you cannot expect a person to “get over it” or just magically “be happy”.
What can be done about the biology portion of this picture? In my previous post I discussed the role of neuroinflammation. There are many ways to help reduce inflammation, including anti-inflammatory diets. Anti-inflammatory diets often come with recommendations for higher fat consumption. Did you know that low serum lipid levels are associated with a 112% increased risk of suicidality, 123% increased risk of suicide attempt and 85% risk of completed suicide ?
And it’s not just the direct effect of the foods you eat on the optimal functioning of each cell in your body. The foods you eat also affect the microbiome of your gut, and the gut microbiome happens to play a crucial, birectional role in mental health . Therapies addressing the gut microbiota, for example through dietary changes, are valuable since the gut microbiota shape your behaviour and mental functioning [2,3].
What’s interesting is that it’s not even simply the bacteria in your gut. It could also be the microbiota (or lack thereof) in your environment, which are hypothesized to help prepare your immune system for optimal functioning and modulate inflammation .
Another lifestyle factor to consider is exercise. Physical activity is associated with balancing out your pro-inflammatory and anti-inflammatory cytokines to help you return to a state of lower inflammation, including neuroinflammation [5,6].
Sleep is another important part of overcoming neuroinflammation. Whether you have insomnia or a crazy schedule, getting suboptimal levels of sleep increases your risk for inflammatory conditions and depression . In populations with existing mental health disorders sleep disturbance was also related to increased suicidal ideation and attempt . Not only is sleep important for improving health outcomes, but it is important because the night means fewer people awake and watching out for those struggling with suicidal ideation and fewer resources at hand .
There are so many factors involved that I can’t do them full justice in this post.
Now perhaps you are trying your best to improve your life, to make yourself healthier and happier but just aren’t getting results. For example, maybe your doctor gave you Chantix in an effort to help you quit smoking but for some reason your mental state seems to keep getting worse. Chantix has taken a lot of heat for a rash of suicides in its users, and now carries a black box warning for depressed mood and suicidal thoughts and actions .
It’s important to find a physician that takes into account you as a whole person. A doctor who will spend more than five minutes to understand what treatment is best for you. Diet, exercise, sleep, sunshine…so many factors that you do have power over in your life. Find a doctor who will help you make the appropriate modifications to get you back on track (see “How do I select a practitioner?”).
Being “happy” isn’t about material things in life, it’s about being healthy. Imagine being a millionaire, or being famous, and still taking your own life. Maybe you’ve heard of people saying things like “why would he do this, he had everything…” Imagine being engulfed in flames and your only option is to jump out of the window (read David Foster Wallace’s analogy here). If you’ve ever seen comments on news articles you know that there are people who don’t understand. You know that there are also people who can be cruel. Don’t worry about them – you do your part to help others or to seek those who can help you. It can be hard for people to understand suicide in the context of:
Beautiful people. “They say I’m lucky to be alive. It’s hard to figure out – when everything I feel hurts!” Marilyn Monroe died in August of 1962 at the age of 36, despite a bright career [11,12].
Funny people. “It lays in wait for the time when you think, ‘It’s fine now, I’m O.K.’ Then, the next thing you know, it’s not O.K.” Robin Williams died in August 2014 at the age of 63, after years of bringing laughter and entertainment into others’ lives .
Tough people. "He had a huge heart and he really didn’t like for people to worry about him” [14, quote from friend, Bieksa]. August 2011 saw the death of 27-year-old Rick Rypien who scored his first goal in his very first game with the Vancouver Canucks and was known for his willingness and ability to fight players much bigger than himself .
People who are so beautiful they make you self-conscious, people who make you laugh, people who are physically strong, even people that seem happy on the outside… Mental health problems can affect a wide range of people.
Are you a guy? Do you struggle with depression? Go get help. It’s okay to get help. I’m saying this because even though men are dealing with this at the same rate as women they are less likely to seek help [16,17]. Men are also more vulnerable to the increased risk of suicide seen with the combination of SSRI use and seasonality . If you are not a guy or are not struggling with depression yourself, look out for the guys in your life that aren’t looking out for themselves (read here for more on men and depression).
Whoever you are, you are worthy of help.
The staggering cost of suicide is forty-four billion dollars a year yet what is that in the face of the precious 42,773 lives that are lost in a year . Watching the heartbreak of a family who has lost a child, grandchild, spouse, sister, brother, aunt, uncle, cousin to suicide is anguishing. No amount of money can bring them back.
Am I the only one I know
Waging my wars behind my face and above my throat
- Migraine, Twenty-One Pilots
You are never alone, you are not the only one. There are communities (Suicide Watch, To Write Love on Her Arms, Active Minds, Mind Check, Living With) of volunteers and programs (Vital Mind Reset, Hockey Talks) meant for support all over the world. There are even apps for suicide prevention (My3, Jason Foundation, Ask)! If you need help please reach out. You can find local resources here or call a 24 hour helpline (click the link on the top of the page to view options).
World Suicide Prevention Day is not just today. Suicide Prevention Day is every day. We all know somebody we can help look out for.
We all have a place in prevention. Artists inspire, educators inform, activists create awareness, scientists seek understanding, doctors heal, friends are there when you need them…we are all part of the solution.
Now the night is coming to an end
The sun will rise and we will try again
Stay alive, stay alive for me
- Truce, Twenty-One Pilots
Together, we can do this. Dare to live. Reach out.
(American) National Suicide Prevention Helpline: 1.800.273.TALK (273-8255) Crisis Text Line: TEXT "TWLOHA" TO 741-741
Canadian Mental Health Crisis Line: (888) 353-2273
Visit TWLOHA for more resources and crisis lines.
Wu S, Ding Y, Wu F, Xie G, Hou J, Mao P. Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies. J Psychiatry Neurosci. 2016;41(1):56-69.
Rogers GB, Keating DJ, Young RL, Wong ML, Licinio J, Wesselingh S. From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry. 2016;21(6):738-48.
Logan AC, Jacka FN, Craig JM, Prescott SL. The Microbiome and Mental Health: Looking Back, Moving Forward with Lessons from Allergic Diseases. Clin Psychopharmacol Neurosci. 2016;14(2):131-47.
Lowry CA, Smith DG, Siebler PH, et al. The Microbiota, Immunoregulation, and Mental Health: Implications for Public Health. Curr Environ Health Rep. 2016;
Barry A, Cronin O, Ryan AM, et al. Impact of Exercise on Innate Immunity in Multiple Sclerosis Progression and Symptomatology. Front Physiol. 2016;7:194.
Spielman LJ, Little JP, Klegeris A. Physical activity and exercise attenuate neuroinflammation in neurological diseases. Brain Res Bull. 2016;125:19-29.
Irwin MR, Opp MR. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology. 2016
Stubbs B, Wu YT, Prina AM, Leng Y, Cosco TD. A population study of the association between sleep disturbance and suicidal behaviour in people with mental illness. J Psychiatr Res. 2016;82:149-154.
Littlewood DL, Gooding P, Kyle SD, Pratt D, Peters S. Understanding the role of sleep in suicide risk: qualitative interview study. BMJ Open. 2016;6(8):e012113.
Available at: http://www.chantix.com
Available at: http://marilynmonroe.com
“Marilyn Monroe”. Available at: http://www.biography.com/people/marilyn-monroe-9412123#famed-career
Itzkoff, D. (2014). “Robin Williams, Oscar-winning comedian, dies at age 63”. The New York Times. Available at: http://www.nytimes.com/2014/08/12/movies/robin-williams-oscar-winning-comedian-dies-at-63.html?_r=0
“Brothers forever: The Bieksa-Rypien story from last year. (2011). The Vancouver Sun. Available at: http://vancouversun.com/news/staff-blogs/brothers-forever-the-bieksa-rypien-story-from-last-year
“The quiet hero”. Available at: https://mindcheck.ca/quiet-hero
Winerman, L. (2005). “Helping men to help themselves”. American Psychological Association. Available at: http://www.apa.org/monitor/jun05/helping.aspx. Accessed September 5, 2016.
Kersting, K. (2005). “Men and depression: battling stigma through public education”. American Psychological Association. Available at: http://www.apa.org/monitor/jun05/stigma.aspx
Makris GD, Reutfors J, Ösby U, et al. Suicide seasonality and antidepressants: a register-based study in Sweden. Acta Psychiatr Scand. 2013;127(2):117-25.
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