Antidepressants and suicide are an odd combination. On the one hand, antidepressants reduce depression, which is a major cause of suicide. But – and this is an important “but” – there is also consistent evidence that, in a very small proportion of adolescents and young adults, antidepressants can trigger suicidal thoughts and suicide itself.
Before I continue, I must note that even with the dangers of antidepressants to adolescents and young adults, antidepressants appear to do more good than harm when it comes to suicide prevention. As a result, for most adolescents and young adults it can be more dangerous to not take antidepressants.
And it is also important to note that there is not consistent evidence that antidepressants increase suicide risk at all for adults older than 25. In fact, one study found that depressed adults, especially those older than 65, who took antidepressants called serotonin reuptake inhibitors (drugs like Prozac and Paxil) were less likely to die by suicide than those who did not take antidepressants.
Increased Risk of Suicidal Thoughts in Young People
For adolescents and young adults, the story is quite different. Adolescents who took antidepressants in one review of studies were twice as likely to attempt or die by suicide than those who did not. There is also evidence that antidepressants may increase the risk of suicidal thoughts and behaviors in young adults under 25.
As a result of the increased danger for suicidality in adolescents and young adults, the U.S. Food and Drug Administration issued a “black box” warning for antidepressants in these age groups. This warning to physicians is one step short of removing the drugs from the market for adolescents and young adults.
Do Antidepressants Do Less Harm than Good?
Interestingly, the year that the FDA’s warning took effect, rates of antidepressant prescriptions to adolescents dropped by 20%, and the suicide rate for adolescents increased by 20%. It’s impossible to know whether the timing of these events was a coincidence or a cause-effect relationship.
Another study of antidepressant use in children and adolescents found that the benefits outweigh the risks. Adolescents effectively helped children and adolescents to recover from depression, anxiety, and obsessive compulsive disorder.
Also important to note is the tiny fraction of adolescents and young adults who experience increases in suicidal thoughts or behaviors (seemingly) due to antidepressants. According to one study, the increased occurred in 1 in 1,000 when it came to suicide attempts and 1 in 3,000 for suicide.
It has been hard to determine definitively the increased risk of suicide, suicide attempts and suicidal thoughts caused by antidepressants. Depression itself causes suicidal thoughts, so an increase in suicidal thoughts would be expected in depressed people, especially those for whom antidepressants simply are not effective. Studies of suicide risk with antidepressants, though, include comparison groups of depressed people who take a placebo (a pill that has no medicine in it). This enables researchers to take into account in their statistical analyses how much suicidal thoughts progress naturally.
The Mystery of Antidepressants’ Effects on Suicidality
Why would antidepressants, which have been shown to decrease depression, actually increase the danger of suicide and suicide attempts? Various reasons have been proposed. The medications might, paradoxically, worsen depression. Alternatively, they might energize people who previously were too paralyzed by depression to act on their suicidal thoughts. It also is known that antidepressants can cause, in some people, intense feelings of agitation and restlessness. These sensations may prompt a person to feel desperate for escape.
Parting Advice about Antidepressants & Suicide
The takeaway message from all of this is that physicians, clients, and parents need to be especially mindful of any increases in suicidal thoughts or behaviors in adolescents or young adults that occur after starting the medication. For the small percentage of adolescents and young adults who worsen with antidepressants, another medication or therapy will need to be tried.
Still, chances are far better that adolescents and young adults will feel better with antidepressants than that antidepressants will do them harm.
© Copyright 2013 Stacey Freedenthal, PhD, LCSW. All rights Reserved. Written For: Speaking of Suicide. Photo purchased from Fotolia.com
SSRIs can put a person into high anxiety/agitation
as in a manic/hypomanic episode. IF/when that happens, it may mean that person has some level/degree of bipolar disorder instead of unipolar depression.
Since the brain actually creates new structures within a matter of days to compensate for what the drug is doing I would assume that you are suggesting that antidepressants are a cause of bipolar then? Seeing as the brain had to physically change for the person to start showing symptoms of a manic episode.
Funny that medical proffesionals tell us that drugs like LSD, MDMA etc… (that also affect levels of serotonin in the brain) can cause serious mental health problems and yet tell us that antidepressants are completely safe and effective.
Chad Ryals, 43, Lumberton, MS, shot himself in the chest, then the eye, then drove to my street still alive, got stuck in a ditch in my neighbors yard and proceeded to repeatedly drive forwards and backwards until he slumped over. Suicidal for many years, never took his life. About a week after he took the medicine his psych forced on him (that he was desperate not to take), dramatic suicide.
This happened about 4 nights ago. The 14th of August, 2016. RIP Chad Ryals You will be missed. The injustice is great.
Feb 88 “smashed” back of my head. April 88 admittted to psych hospital with suicidal ideation (flying off a bridge in car to end life, “wanting” to go to top of bldg to jump off.) Re-hospitalized because suicidal again in July 88. Loooong story short. 28 yrs later, here I am in 2016, still on meds. After different meds, I was on Pamelor (tricyclic) for many yrs. Became intolerant(?) switched to Prozac had allergic reaction. Switched again to Zoloft. Then switched to generic sertraline to this day. Have tried to wean from meds many times, with no success. I had to accept that I had to be on meds until natural death? In no way do I want to commit suicide. I don’t even like to take aspirin for a headache… In the meantime I have had cancer twice. Strange as it may “sound”, I would rather die from cancer, rather than suicide! I truly believe that I would go to Hell, if I committed suicide, even tho at the time I was agnostic…. What also upsets me so much is that so many times I see that people say that anti depreesants CAUSE suicide. From my experience, anti-depressants have SAVED my life…Until the meds could do their work, I was suicidal. Patients need to work with Psychiatrists to get to the therapeutic level of their meds. It took me several hard months to get back to “normal” functioning as a human being. I am a loner and feel definite ostracization from people due to the horrible stigma of being mentally ill. I thank God daily, for my sertraline helping me to be as normal as I can be……. I am concerned, that due to the “false” belief that anti-depressants cause suicide, that my med might be taken “off the market. ” I hope and pray that doesn’t happen. I also remind myself daily that it could be much much worse. God Bless us all, in our daily struggles to remain sane.
I was on Quite a Few Medications:
Wellbutrin
Zyprexa
Amitriptyline
Seroquel
Atavan .
etc.
The More Pills, I Took – The Worse My Condition became…
I was Unable to Function… and my Dr. Kept Prescribing MORE and MORE.
I could hardly mow the lawn for 15 minutes.
I fainted One Christmas, just after I took the Turkey Out of the Oven. Bashed My Chin On the Counter and Fell to the Floor!
That’s when I Realized I had to Get Off the Meds. They were Making Me WORSE! I also got rid of My Doctors.
It had Taken 2 Months+ to get them Out of My System – To Clear My Head!
I have NO REGRETS – 10+ Years Later.
I actually got my Life Back… though it’s Not Perfect.
I Know Many ( Some in Institutions) that have Cocktails and they Do Not Seem to Do Well..
I believe Psychiatrists – OVERPRESCRIBE and Mis-Diagnose.
It’s Up to the Individual to Decide if they are Taking the Correct Path.
Don’t be Afraid to Reflect on Your Course, Nor to Turn Back and Correct it if it’s not working.
Medications can have LONG LASTING EFFETS, even when they are Discontinued… which I’m Sure I Suffer From with Memory Loss associated with My Experiences.
Sleep Deprivation is another Symptom, I try to Offset with Natural Remedies.
My 15 year old son was not doing his school work and just seemed to have a lack of motivation. Our family doctor put him on a low dose of Prozac and a month later at the med check appointment she doubled the dose after looking again at his height and weight (he was 6 foot tall) he was dead 3 weeks later by a gunshot. He showed no signs and had so many friends and a girlfriend. My therapist says it was the medicine. I really believe it was. I am 5 days away from the year mark. I want to find answers.
I am so sorry for you loss.
Im so sorry for your loss.
I m so sorry for your loss
My 17-yr-old brother committed suicide three weeks after starting an antidepressant. I feel like we would have watched him closer if we had been warned about the increased risk of suicide after starting an SSRI. Reading about this subject makes me ill because I feel like I am partly responsible for losing him.
Stephanie,
I am sorry for your loss. How devastating, first, to lose your brother to suicide, and, second, to feel partly responsible for his death. I hope you will also read my post “If Only”: Self-Blame After a Loved One’s Suicide. It speaks to the tendency we humans have to blame ourselves for events out of our control, and how to counter feelings of self-blame.
Your comment is very incisive and raises many of the arguments about why and how suicide can be “rational.” As you convey so well, a major argument is that if a person’s suffering is profound and with no foreseeable end, then suicide is rational.
One of the things that keeps me going as a therapist and researcher specializing in suicide prevention is my constant exposure, both in real life and in historical literature, of people who experienced unfathomable suffering yet did not, as the proponents of rational suicide argue, inevitably die by suicide. Instead, even in the most extreme cases, the survival instinct enabled them to endure physical torture, traumatic loss of family members, starvation, and more – conditions for which others would consider suicide to be a rational response.
Here I am thinking most intently of Victor Frankl, who experienced the above conditions as a concentration camp prisoner in the Holocaust and who, in his book Man’s Search for Meaning, wrote passionately about people’s ability to endure any degree of suffering. There are legions of others, too, who did not die by suicide even amid years of sexual slavery, captivity, etc. You might argue that they did not have access to the weapons for suicide, but the forces of suicide can inspire almost maniacal creativity and resourcefulness in the service of death. Means for suicide are never absent.
What prolongs life amid excruciating suffering? The survival instinct is an overwhelming life force. Every part of our being is programmed to survive, no matter the horrors we endure. (Again, you may find inspiration in accounts of Holocaust survivors. As with any group, some did die by suicide but the vast majority did not.)
In some people, this survival instinct somehow becomes impaired or deadened, whether due to mental illness, substance abuse, extreme stress, or some other force. Again, in the face of so much evidence of people whose survival instinct remained intact amid extreme suffering with no end in sight, I do not accept that it is healthy or normal for this survival instinct to wither. Instead it is a sign of severe emotional injury, and this injury, like so many other injuries, can be healed.
Thank you for sharing your insights. Let me add just one thing: thousands of people die every year from overdoses and a smaller number die from lacerating their wrists. To call these people (or those who survived attempts by similar means) “weaklings” as you did seems inconsistent with your otherwise eloquent and compassionate recognition of the formidable suffering that people can experience in their life. Words such as weakling and coward have been applied over the ages to people who survive a suicide attempt and, paradoxically, to those who die by suicide. They are, in my opinion, simplistic judgments that belie the complexities of suffering whose depths and nuances inherently make us outsiders to the person’s inner world.
I’m 26, was on paxil for 2 weeks just for anxiety… been off for 10 days now. I’m struggling with my thoughts …I was never suicidal before
Go to the website survivingantidepressants.org, there is a lot of help there.
Yana
My 21yo brother killed himself 3 weeks after starting his antidepressant. Young people need close and constant expert care, especially in the first few months of starting medication.
Juliapaz, I am so sorry about your brother. You are absolutely right about the need for constant monitoring of young people after they start antidepressants. The “black box” warning that the FDA requires specifies that antidepressants can increase risk for suicide up to age 25. Still, regardless of age, the “black box” warning states, “Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.”
My best wishes to you and your family.
My 23 year old girlfriend took her own life after just three weeks on anti depressants, she stopped suddenly due to me being wary of the medication she was taking, I wasn’t aware of the medication or potential side effects, all I saw was how they made her feel when she started taking them in the first place, slurred words, eyes rolling, I was shocked and wary from then on, and when I saw that Rose had improved vastly after three weeks, I asked her to stop.
She did and became increasingly agitated and confused, she died on the 15th of February last year, I truly believe it’s partly my fault and now I too sometimes wish to die, I am not taking any medication but also don’t think I have the guts to go through with it, life is so cruel at times.
Mark,
I am so sorry for your loss. I hope you will consider calling the National Suicide Prevention Lifeline to get help for your own wishes to die. The number is 1.800.273.8255 (TALK).
There are also many other places where you can get help by phone, text, email, or chat. I provide a list of those resources here.
If you are in an emergency, please call 911 if in the U.S. or whatever the emergency number is where you live.
Finally, in terms of the blame you direct at yourself for your girlfriend’s suicide, maybe this post will be helpful to you: “If Only”: Self-Blame After a Loved One’s Suicide.
I would be interested in a blog on prescription psychoactive drugs that are hard to get off of, such as Effexor and Abilify. It took me a year and several hospitalizations to get off Effexor, and right now am risking death, psychosis, and severely uncomfortable moods by dropping from 30 mg to 5 mg. I am scared to see what will happen when I go to 2.5 mg. I have symptoms of TD, so I must go off of it.
Going off psychotropic meds can be a real issue, as you have learned the hard way.
These days, articles are constantly appearing in the popular press about how long people are using antidepressants. People with multiple episodes of major depression are sometimes advised to stay on the drugs for life. I say – whatever works! But if someone does want to go off the medicines at some point, they need to be prepared to do it under medical supervision, and to NOT stop abruptly on their own.
Thanks for sharing your story. I’m sorry you’re having so much trouble. I hope you are able to find something for you that is safe and effective.