Greetings, Dr. Roach It appears like a lot of the drugs I see promoted on TV come with a warning concerning suicidal thoughts. Could you explain why this adverse effect is common to so many different medications? — W.S.
ANSWER: Sadly, suicide is an all too common cause of death that many people find awkward to discuss. Nonetheless, it is evident that there are efficient methods for lowering the risk of suicide, particularly when it comes to identifying high-risk individuals through screening and using efficient treatment modalities.
The Food and Drug Administration takes any safety signal seriously since suicide deaths are so significant, and makers are required to notify consumers about it in advertisements and on the package insert. A warning, however, does not always imply that there is concrete proof that this medication raises the risk of suicide.
Since suicide is a complex topic, there is conflicting research regarding the risk of suicide from drugs. Studies employ complicated methodologies; for instance, an individual with depression is more likely to be prescribed an antidepressant, yet these medications do not immediately begin to function. Given that those who are prescribed antidepressants are more likely than those who are not to try suicide or die by suicide, a cursory investigation may conclude that antidepressant use raises the risk of suicide.
Using a different methodology, a 2019 study examined suicide attempts three months before and three months after receiving a prescription for medicine. This made it possible for the researchers to find 44 drugs that reduced suicidal episodes and 10 drugs that significantly increased the risk of suicide in the three months following initiation.
The risk was elevated by certain combinations of opiates. Acetaminophen/butalbital/caffeine; hydrocodone with acetaminophen; and codeine phosphate/promethazine or promethazine alone all increased suicide risk by 30% to 70%. Additionally, sedatives like diazepam and alprazolam raised the chance of suicide. Both the antibiotic azithromycin and the steroid prednisone raised the risk of suicide. Suicide risk was also raised by the muscle relaxants carisoprodol and cyclobenzaprine.
This list does not imply that prescriptions for these medications should be avoided. Some of these medications must be taken at specific times. However, physicians should think about whether an alternative might be better or if they should at least warn patients that this is a potential side effect.
Of the 44 drugs that decreased suicide risk, most were antidepressants and antipsychotic drugs. Not surprisingly, drugs that help with addictions to alcohol and opiates reduced suicide risk. However, there were some blood pressure medicines, antiseizure medicines, and seemingly random drugs like folic acid and pantoprazole that decreased suicide risk.
Some drugs that had been suspected of suicide risk, like sleeping aids and the asthma/allergy drug montelukast, did not show any positive or negative effect in this study, which is limited by a three-month dataset.
What is most important to recognize is that a diverse range of medications can have powerful effects on our minds and emotions. Recognizing that this happens should make it easier for people who have suicidal thoughts to get in touch with their medical provider or a mental-health professional quickly to identify the problem and get help if needed.
In both the United States and Canada, the Suicide and Crisis Lifeline is 988. This lifeline connects a person to a skilled counselor.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions [email protected] send mail to 628 Virginia Dr., Orlando, FL 32803.
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