Stock photo. Not actual patient.
When Suicidal Thinking Indicates a Bigger Clinical Picture
Every patient has a unique biology. Assessing the patient holistically to determine the root cause of suicidal thinking can reveal important opportunities for personalized care.
Jenna, a 44-year-old woman, developed severe obsessive-compulsive symptoms abruptly following an influenza infection. Her symptoms quickly became debilitating. Contamination fears made everyday activities extraordinarily difficult. Getting dressed could take two hours. She struggled to bathe, shop, cook, care for her two young children, or run her business.
Jenna also experienced severe anxiety, fragmented sleep, intense fears about illness and death—and suicidal thoughts, although she reported no intent or plan.
Rather than viewing these symptoms in isolation, her clinical evaluation explored a broader question: What factors might be contributing to this sudden and dramatic change in her mental health?
The assessment identified several areas requiring attention, including:
- Iron deficiency: Ferritin was 15 and iron saturation was 11%.
- Low vitamin D: 25(OH) vitamin D was 24.
- Hormonal changes: She was experiencing perimenopausal hormone fluctuations, PMDD symptoms, and dysfunctional uterine bleeding.
- Possible post-infectious factors: Her severe OCD had begun abruptly following influenza, and additional testing raised questions about infectious and immune contributors.
- Environmental factors: Mold was identified in the home, prompting recommendations for remediation.
A Multi-System Treatment Approach to Psychiatric Symptoms
Treatment was individualized to address both Jenna’s psychiatric symptoms and the biological and medical findings identified during the evaluation.
Her treatment plan included nutritional repletion, omega-3 fatty acids, lithium orotate, low-dose naltrexone, hormonal support, and interventions directed toward identified infectious and environmental concerns. Evidence-based behavioral interventions, including exposure and response prevention (ERP) for OCD and CBT approaches for insomnia, were also recommended.
Over approximately three months, Jenna experienced a significant reduction in OCD and anxiety symptoms. Her suicidal ideation resolved. She was again able to care for her family and home and was planning her return to work.
The Clinical Lesson: Identify the Root Cause of Suicidal Ideation
Suicidal thinking always requires immediate and careful assessment. But assessing safety is not necessarily the end of the clinical investigation.
This case illustrates why clinicians may also need to ask:
What has changed? What could be contributing to this patient’s psychiatric symptoms? And are there biological, nutritional, hormonal, medical, environmental, or other factors that deserve investigation?
During Suicide Prevention Awareness Month, this case is an important reminder of the value of looking beyond symptoms alone.
Every patient has a story. Every patient has a biology. And sometimes, asking what may be contributing to suicidal thinking can reveal important opportunities for more personalized care.
