We are living through some really rough times. Even before the coronavirus pandemic, tens of millions of Americans were anxious or depressed. Young adults have been hit especially hard. Many are experiencing depression and feelings of hopelessness. Doctors frequently prescribe antidepressants like sertraline, escitalopram and bupropion. They may not always tell patients and their families to be on the lookout for thoughts of suicide.
An Update from The Washington Post/Bloomberg:
An analysis by Niall Ferguson in the Washington Post/Bloomberg (Feb. 26, 2023) was titled:
“US Teens Feel Down, But the Adults Aren’t All Right Either”
The numbers cited are scary!
“Let’s look at the statistics (there are plenty). According to the non-profit advocacy group Mental Health America’s 2023 report (which is based on 2020 data), 11.5% of American kids aged from 12 to 17 are ‘experiencing depression that is severely impairing their ability to function,’ while 16.4% report ‘suffering from at least one major depressive episode in the past year.’ This is a problem that is getting worse over time. According to Office Practicum, there was ‘a 27% increase in anxiety and a 24% increase in depression between 2016 and 2019’ in this teenage group.”
We suspect things are significantly worse today!
How Many People Are Taking Antidepressants?
Our back-of-the-envelope calculations suggest that nearly 40 million citizens of the U.S. are taking antidepressant medications. At last count, over 200 million pill bottles were dispensed annually. If each bottle contains 30 pills, that equals 6,078,000,000 pills!
Keep in mind that was before the coronavirus. From all indications, people are far more distraught today than they were three years ago when these statistics were gathered.
Because antidepressants are dispensed to so many people so regularly, we fear that prescribers and patients may take them for granted. That could mean that families are not warned about thoughts of suicide that can be triggered by drugs like:
Sertraline
Escitalopram
Bupropion
Trazodone
Citalopram
Fluoxetine
Duloxetine
Venlafaxine
Amitriptyline
Nortriptyline
Where Did The Thoughts of Suicide Come From?
A visitor to this website wonders where this disturbing thought came from:
Q. After taking just a couple escitalopram pills, I found myself wondering which side of my neck was best for cutting. I had no idea where that disturbing thought came from.
When I told my doctor, he told me to stop taking the drug. Is it possible for antidepressants to trigger suicidal thoughts? What else could I do to shake my depression?
A. Escitalopram (Lexapro), like many similar drugs, comes with this warning:
“Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.”
There is controversy about whether antidepressants have this effect on middle-aged individuals as well. Anyone who experiences thoughts of self-harm should follow your example and check with the prescriber immediately.
You can learn more about other strategies for managing depression in our Guide to Dealing with Depression. This online resource can be found under the Health eGuides tab. It discusses talk therapy, exercise, light therapy and some supplements.
What Can Happen When People Are NOT Warned About Thoughts of Suicide”
This father wishes his son was warned about thoughts of suicide before being prescribed an antidepressant:
Q. As a grieving father who lost his beautiful son to suicide, I would like to write about the dramatic increase in antidepressant drug use. Too many doctors are writing prescriptions for off-label use.
Doctors expect their patients to monitor changes in their own mental health, even though antidepressants carry a black box warning about suicide ideation. This clearly states:
Families and caregivers should be advised of the need for close observation and communication with the prescriber.”
In my experience, this is not happening.
People with mental health concerns should receive counseling before being prescribed any psychotropic drug. In my son’s case, his university psychiatrist treated “age-appropriate stress” as a mental illness and prescribed him paroxetine and clonazepam. That resulted in suicide ideation.
The thing that angers me the most is an answer my son wrote on a questionnaire in his medical records:
“I wish I could feel the same as I did before taking psychotropic drugs.”
If my son had never been prescribed psychotropic drugs, he would be alive today, happy and healthy.
A. We are so sorry to learn about this tragedy. We agree that everyone who takes antidepressants should be carefully monitored by friends and family for thoughts of suicide.
You are right that the FDA has required a black box warning (the strongest warning there is) with most antidepressants. There is a clear statement about the emergence of thoughts of suicide.
Here is the full statement that might have protected your son:
“Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older.
“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.”
Other Stories About Antidepressants and Thoughts of Suicide:
Barry developed thoughts of suicide after taking citalopram.
“After 15 years building a business, a change of directors put my workload levels at a breaking point. I was raised to just get on with it and not moan or complain. I believed mental illness was just a weakness of character.
“The stress was too much for me. I broke down and was put on the antidepressant citalopram. To get to sleep my doctor prescribed zolpidem. The sleeping tablets worked. The antidepressant made me feel worse.
“I have never before felt anything like wanting to commit suicide. With much help and care from my family I got through this very dramatic time in my life.”
Kate developed thoughts of suicide while taking a generic antidepressant:
“I was suicidal within days of taking a generic antidepressant made in India. I do not trust generic drugs from foreign suppliers. Your pharmacy will not take responsibility.”
Rob was taking duloxetine and developed thoughts of suicide:
“I was placed on duloxetine for depression, anxiety and nerve pain. I did get some relief from the neuropathy but not for the depression. The doctor phased me off duloxetine and moved me to escitalopram.
“After 17 days I feel like crap. Side effects include nausea and gas. I also have the jitters and light tremors throughout my extremities. And I have had on and off again thoughts of suicide. My psychiatric nurse practitioner will need to come up with some alternate approach.”
The People’s Pharmacy Perspective:
We know that it seems counterintuitive to warn people that an antidepressant medication might lead to thoughts of suicide. But the FDA believes such a warning is warranted. Not only that, but friends and family should be notified so that they can monitor any worrisome thinking patterns or behaviors in patients prescribed antidepressants.
Share your experience with antidepressant medications in the comment section below. How well have they worked for you? Have you experienced any side effects? What about thoughts of suicide or sexual dysfunction? Here is a link to an article about this delicate subject:
Sexual Side Effects Are Common
Challenging the Serotonin Theory of Depression:
We have lost faith in the serotonin deficiency theory of depression. The idea that medications can correct the neurotransmitter “imbalance” has been very popular for decades. You may wish to listen to Dr. Joanna Moncrieff challenge the serotonin theory of depression.
Dr. Moncrieff is Professor of Critical and Social Psychiatry at University College London and works as a consultant in community psychiatry in London. She is one of the founders and the co-chairperson of the Critical Psychiatry Network. She has authored numerous papers and several books including The Myth of the Chemical Cure, The Bitterest Pills: The Troubling Story of Antipsychotic Drugs and A Straight-Talking Introduction to Psychiatric Drugs. Dr. Moncrieff’s article on the serotonin theory of depression is here.
Our free podcast with Dr. Matthew Schrag and Dr. Joanna Moncrieff can be accessed at this link. Both guests challenge the dogma of how the brain works. Dr. Schrag questions the amyloid theory of Alzheimer’s disease and Dr. Moncrieff questions the serotonin theory of depression. You can listen to the streaming audio or download the mp3 file at this link. And please share your experience with such medications in the comment section below.
Words of Caution!
No one should ever stop taking prescribed medications without discussing this with the prescribing physician. Stopping antidepressant drugs suddenly can trigger very challenging withdrawal reactions. If it becomes appropriate to stop such medicines, it must be done under very careful medical supervision.
The gradual taper may take many months. There must also be support therapy available during this process. Dr. Moncrieff discusses the problems associated with antidepressant withdrawal during this podcast.
