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.