sad and depressed young woman crying

Can antidepressants lead to suicidal thoughts and actions? This controversial question about antidepressants and suicide has been hotly debated for over 25 years.

Not long after Prozac (fluoxetine) was introduced in 1987, we started hearing about tragic suicidal events affecting people taking this drug. Initially, we were skeptical. How could a drug intended to improve mood and lessen suicidal thoughts make such problems worse?

By the way, the assumption that antidepressants should prevent suicide is not backed up by evidence from randomized controlled trials (RCTs). A review (Psychotherapy and Psychosomatics, online, April 5, 2016) of 29 long-term studies of antidepressants involving 6,934 patients concluded that:

“Therapists should be aware of the lack of proof from RCTs that antidepressants prevent suicides and suicide attempts.”

A Letter Forced Us To Reconsider Antidepressants and Suicide:

In the spring of 1990 a physician wrote to us about his 40-year-old daughter. She was married and had two teenaged daughters and worked as a nurse. He was convinced that she hanged herself because of Prozac.

It was prescribed for her for an eating disorder in January of 1988. Just before she killed herself in February of that year, she promised to take care of a neighbor’s cats for several days. He felt that she would never have made such a commitment if she had been planning to commit suicide.

His letter was poignant and worrisome. We were still unsure of the relationship between antidepressants and suicide, but for the first time we began to question our belief that there could be no connection.

In February of 1990, an article was published in the American Journal of Psychiatry reporting on six patients who suddenly developed “intense violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment.” 

When we contacted the manufacturer, Eli Lilly, we were told in a letter dated June 19, 1990, that:

“The incidence of suicidal thinking or acts did not differ significantly among patients treated with Prozac, placebo or tricyclic antidepressants.”

The company’s position in those days was that there was no support for the idea that Prozac could cause suicidal ideation or behavior in either depressed or non-depressed patients.

The Violent Nature of Suicide:

What struck us about some of the messages we were were receiving was the unusual nature of the suicides, especially among young women. When we consulted others we were told of stories about young women who shot themselves, burned themselves to death, jumped off freeway bridges or hung themselves. These violent cases were out of character for the individuals and for women in general.

One young women told us that while she was traveling as a passenger in a car on the interstate she heard a voice that urged her to open the car door and jump out. She had never heard inner voices before this terrifying event. She said it took superhuman effort to resist jumping out of the car at 65 mph to her death.

Antidepressants and Suicide 2016:

Fast forward to 2016. Although there are still health professionals who do not believe antidepressant medications like duloxetine, fluoxetine or sertraline could trigger suicidal thoughts, the FDA requires that such drugs come with strong black box warnings similar to this one for fluoxetine:

“Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies…In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.”

Such warnings were too late to protect many people. One mother wrote in 1991:

“I suspect the drug fluoxetine may be implicated in the death by self-immolation of my daughter…fluoxetine intensified my daughter’s anxiety to an unbearable degree and provoked self-injurious and highly dangerous behavior that had not been present before taking the drug and that eventually proved lethal.”

“The degree of anguish and fear my daughter suffered was intense. She was terrified by violent obsessive thoughts of killing herself. It was not until July of 1990 that there was any public information to substantiate our concerns and by that time it was too late as our daughter had already succeeded in lethally burning herself.”

Drug Company Denials:

The drug company’s insistence in 1990 that there was “no causal relationship” between Prozac and suicide attempts is consistent with other pharmaceutical manufacturers’ responses to bad news. For the 40 years that we have been studying drug safety issues, we have often seen initial resistance or denial of a problem that later proved serious or deadly.

In the case of antidepressants, no one could imagine that drugs prescribed to prevent suicide could actually contribute to that very outcome.

Family members and patients themselves are often able to detect adverse drug reactions long before companies or federal regulators acknowledge them. We have seen that with statin-type cholesterol-lowering drugs and severe muscle problems. (Listen to our radio show of 4/9/11 with Steve Nissen, MD, to learn more. Dr. Nissen is head of cardiovascular medicine at the Cleveland Clinic and his interview starts about 35 minutes into the show).

Patients alerted us to severe and long-lasting complications linked to fluoroquinolone antibiotics long before the FDA issued warnings on drugs like ciprofloxacin or levofloxacin. To learn more about drug side effects that the FDA may not even know about yet, visit this link.

When it comes to antidepressants and suicide, in 2016 it is clear that patients and their families must be alerted about this potentially deadly complication. Even if physicians and pharmacists believe it is a rare side effect of such drugs, they have an obligation to heed FDA’s recommendations that patients of all ages who are treated with antidepressants must be monitored for “clinical worsening, suicidality, and unusual changes in behavior.”

Antidepressants and Agression:

One final word of caution: A study published in BMJ (Jan. 28, 2016) notes that in “children and adolescents the risk of suicidality and aggression doubled” after antidepressant treatment. Americans find it impossible to conceive of the idea that a medication could make someone aggressive or homicidal. Nevertheless, the Danish research published in the BMJ suggests that some young people do indeed become hostile or aggressive after treatment with antidepressants.

If you are interested in learning more about this challenging concept we recommend this article: “Antidepressants Linked to Violence, Rape, Robbery and Homicide.” For those who are interested in more information about antidepressants and other nondrug options we offer our Guide to Dealing with Depression.

Please share your own experience with antidepressants in the comment section below and if you found this article of interest, please vote at the top of the page.

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  1. Edie

    I personally experienced nearly everything mentioned in this article.
    When I was 13, I developed and eating disorder that resulted in depression. I was put on Paxil. Within 2 weeks I became suicidal and aggressive. This was 1993 so they added an anti-psychotic and diagnosed bipolar and borderline personality disorder. They weren’t even following DSM guidelines, which stated that personality disorders shouldn’t be diagnosed in those under the age of 18…
    For 10 years I was drugged, institutionalized and blamed for my behavior. I was in the ER weekly to have my stomach pumped or arms and head sewn up… They even put me in jail a few times for assaulting people.

    In 2002, while in a psychiatric hospital, I attempted suicide by self-immolating. While recovering in the burn unit, they discontinued most of my psych meds due to the health issues brought on by severe burns. Six months later I was virtually a different person with no thoughts of suicide, no issues whatsoever.

    A few years later, when my GP prescribed Straterra for ADHD, the irrational thinking and behavior returned with a vengeance. I realized then that the drugs had been the cause of all my adolescent issues. I had often wondered how I went from a GAF of 10 to a fully functional, happy adult. Now I know.

    Every time I hear of a young person killing themselves or their family member, or a mass shooting, I wonder what “meds” they were taking, and I wonder when the rest of the world is going to wake up. I hope it’s not too late. Sending peace and hope to all who suffer. I will never stop praying/hoping for the truth to be exposed.

  2. Kathy
    New Jersey

    I have struggled with depression for many years, going back to my early 20’s. I am now
    62 and was finally dxed with bi-polar disorder. I have been on many different anti-depressants with little , if any, relief. I have been on Tegretol (supposed to regulate my
    mood) over 10 years and I notice I have more aggression and get fired up over the littlest things. Sometimes I think death would be a welcome relief, and then I think my
    family would be devastated if I were to act on those thoughts. One thing I never forget
    is that pharmaceutical companies are in it for the money, nothing else. That’s why I
    do not like taking drugs, they’re not natural, and they all have side affects, some deadly.

  3. helenbee

    Finding the “right” anti-depressant for each individual’s brain chemistry is still a “crap shoot.” My 5 siblings and I are all on SSRI’s for various reasons: depression/anxiety, obsessive-compulsive disorder, fibromyalgia, & an eating disorder.

    One sister has been on Prozac for several years and it has helped her tremendously. My brother tried it and it made him almost manic. He’s on Zoloft and is doing much, much better.

    Depression/anxiety is very rampant in our family and 4 of our nieces/nephews are taking SSRI’s, with good results. My 33 year old daughter was treated for depression after the sudden death of her beloved father when she was just 14. I found a grief counselor/psychotherapist immediately. She was struggling in school and was diagnosed with major depression. She was prescribed a small dose of Zoloft and it was slowly increased.

    Six months to the date after her father died, she tried to kill herself. After several hospitalization and a thorough psychological evaluation, she was diagnosed with bipolar disorder, triggered by trauma and the increased dose of an SSRI. Interestingly, because of severe PMS and then the sudden death of my husband, I started taking Zoloft at the same time as my daughter. It helped me get through one of the worst times of my life, menopause was fairly easy and it still helps me with anxiety and low grade depression.

    It took several years to find the right medication for my daughter (Lamictal and Abilify) and she has been stable for quite some time. We didn’t realize the extent of mental illness on both sides of the family tree when we decided to have children. Now, in addition to my siblings and nieces/nephews, 2 of my late husband’s aunts have been diagnosed with bipolar disorder and there is evidence of mood disorders on both sides of the family.

    All of us would prefer to not be on any psych meds but they have helped us have a functional and better quality life. I have a love/hate relationship with the big drug companies. They shouldn’t be allowed to advertise on TV and other social media because yes, there ARE risks to all anti-depressants and other meds. They come with some serious side effects. There aren’t enough children and adolescent psychiatrists/general psychiatrists and where are the state of the art treatment centers for mental illnesses?? Someday, my daughter and I hope that there will be more precise and individual ways of diagnosing and treating these brain-based illnesses. There is no doubt in my mind that my daughter would be dead today without the right medications. But we both still hate the illness and the medications’ side effects.

  4. Cindy M. Black
    Seattle, WA

    It’s very interesting that antidepressants may increase the probability of suicide by REDUCING depression, i.e., “lightening one’s load.” It’s well known that many people, in the days prior to a planned suicide, tend to present as more lighthearted and upbeat. This may be because they’ve finally made the decision and that burden is no longer on their back. Similarly, a person may choose a much more gruesome suicide on antidepressants because the act, and the manner of death, doesn’t seem quite so horrible now. It’s like, they’re dealing with only a single negative vs. a double negative. I think it’s fascinating that so many suicides occurred AFTER the Bosnian War was over… The mood had lifted a bit, and people weren’t struggling every minute just to keep OTHERS from killing them. But the horrible things they’d witnessed, and the horrible losses, were still there…only now, people had more luxury (and strength) to act on the accumulated negatives. Terribly strange, isn’t it? I think the phenomenon of antidepressants and suicide has many of the same elements. BTW, I worked in psych for many years.

  5. HelenM

    I am not a young person; however, I was on varying doses of prozac and paxil from about 2005 to 2010 when I decided I needed to take fewer drugs. Stopped the paxil, the lipitor, cold turkey. Weaned off protonix. Tho it has been years since any anti-depressant, thoughts of suicide still linger. They were not present before. Nor was this anxiety.

    To be fair: I am not in good health. I have constant pain from scoliosis, spinal stenosis, fibromyalgia, neuropathy and arthritis. I do use gin soaked raisins, as low as possible amounts of opioids, lyrica, to have some functioning and some sleep. So, perhaps, thoughts of suicide are not uncommon in people in my situation. Nevertheless, I battle daily to turn my back on ways to end it all. And, yes, I have had therapy, am “enjoying” it again at this time. How else does someone else, other than my SO, have to listen to my tale of woe? Snark! I do want people my age, my pain and other health related issues, who may be fighting suicidal thoughts to know they are not alone.

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