Suicide Prevention Beyond Lithium: A Role for Folate?

I started Psychiatry Redefined because present challenges and obstacles in our current medical approach to mental health care. Treating patients with a one-size-fits-all, medication-based strategy is rarely the optimal solution to a patient’s mental health symptoms.

Patients are unique, with numerous components that all should be considered, including nutrient deficiencies, hormonal imbalances, gut flora problems, toxicities, chronic infections, genetic factors and personal history.

Recognizing the uniqueness of patients and providing personalized, comprehensive assessment and treatment is the foundation of functional psychiatry.

And like other aspects of a patient’s mental health, suicide risk is one area that is often not well addressed through standard treatment. While lithium has long stood out as a suicide preventative, recent research suggests another nutritional factor that may be important to individuals at risk of suicide: folate.

Almost 46,000 people per year—or one person every eleven minutes—dies by suicide in the United States.

Suicide affects both young and old. In the age group from 10 to 34 years, suicide is the second leading cause of death, while being the 10th leading cause of death overall (Stone 2021).

Even more concerning, during the year 2020, 12.2 million Americans seriously considered suicide. The numbers are staggering and raise obvious treatment concerns.

Yet the only well-proven preventive medicine for suicide is lithium (Wilkinson 2022, Memon 2020). Due to the stigma around lithium and concerns for side effects from pharmaceutical-level dosing, it is rarely used directly for suicide prevention treatment.

Recently, in an attempt to find other cheap and safe tools for preventing suicide, a screening analysis of medical records was conducted to look for correlations between different medications and reduced suicide risks. In the initial analysis, a significant correlation between folic acid prescriptions and reduced suicide emerged (Gibbons 2019).

In an attempt to confirm the findings, an observational study utilizing a database of private health insurance claims was analyzed to assess correlations between folic acid prescriptions and suicide attempts or episodes of intentional self-harm.

In the new study, the link between folic acid and suicide was confirmed, with a reduction in the risk of suicide by folate of 44%. Upon a duration-response analysis, it was found that taking 1 mg of folic acid daily reduced suicidal events by 5% per month (Gibbons 2022).

Considering the low cost and safety of folic acid—and the risks of not intervening—prescribing folate as a preventative to decrease suicide risks in patients who have suicidal ideation could be a simple, cost-effective approach to save lives.

Combined with low-dose lithium, it’s possible that outcomes could be improved even further, although there is, as of yet, no research in this direction to suggest or confirm improved efficacy with the combination.

Ready to learn breakthrough nutritional and functional strategies to help your patients? Enroll in our comprehensive Fellowship! Book a 1:1 call with Dr. James Greenblatt today to learn more.