Jack E. Fincham, PhD, RPh
Jack E. Fincham, PhD, clinical pharmacy faculty affiliate in the Osher Lifelong Learning Institute, University of Arizona, Tucson. OLLI.Arizona.edu
Americans use a lot of medications, filling prescriptions and buying over-the-counter (OTC) drugs several billion times each year. All these medications come with potential benefits and risks. But in the ubiquitous TV and print ads targeted to consumers, the benefits get much more attention than the risks.
Surprising danger you should know about: The use of certain medications is linked to suicidal thinking. That’s right—a medication that you take to feel better might twist your thoughts, suddenly and powerfully, so that you feel bad enough to consider ending your life.
My analysis: When I recently completed a search of Clinical Pharmacology powered by Clinical-Key, a trusted database of drug information, this potential side effect is listed for 188 different drugs, including both prescription and OTC medications that are taken by several million Americans. Use of certain drugs with this possible side effect has also been linked to increased risk for suicide attempts and completed suicides.
To be fair, just because this possible side effect is listed does not mean that a drug always causes suicidal thinking…nor that the drug is to blame if this frightening problem does occur. But it does mean that cases have shown up—either in clinical trials conducted before the drug was approved or in reports sent to FDA regulators after it hit the market.
Unfortunately, it is impossible to say with any certainty how often people experience this (or any other) side effect in real-world use. That’s because not everyone having a problem reports it, nor do regulators hear from people who have no problems with the drug.
Still, if suicidal thinking is a possible side effect of a drug you’re taking for, say, depression, asthma, allergies or acne, it’s something you want to know so that you, your doctor and the people close to you can be on the alert—and fully consider all the risks and benefits of that medication or alternatives.
Important: Do not stop taking a medication your doctor has prescribed without checking with the doctor or pharmacist. Some drugs may have additional side effects if stopped abruptly.
Among the medications that have been linked to suicidal thinking…
• Montelukast (Singulair). Singulair is the best known of a group of medicines known as leukotriene inhibitors. Usually taken in pill form, it is used to treat asthma and, in some cases, nasal allergies. Other drugs in this class include zafirlukast (Accolate) and zileuton (Zyflo).
Since 2009, the FDA has required these drugs to carry labels saying that suicidal thinking and actions (and mental health problems such as anxiety and depression) have been reported in some patients.
My advice: Assuming you’ve talked with your doctor about the risks and potential benefits and have decided to use a leukotriene inhibitor, stay alert for any changes in your typical feelings and thoughts. If any occur, it may be that you could safely use another drug, such as a beta-agonist, or switch to something else entirely, such as an inhaled corticosteroid. These medications have not been linked to suicidal thinking.
• Antidepressants. While studies in older adults have not found a definitive link between antidepressant use and suicidal thinking, studies in children, teens and adults under age 25 have been concerning enough to lead the FDA to put so-called black-box warnings (the strongest kind) about the possible risks for young people on all antidepressants.
It’s unclear why young people might be especially vulnerable to such a drug side effect. Perhaps medical providers and parents are more vigilant and more likely to report known suicidal thoughts or attempts when the patient is young. Or perhaps young brains react differently to the drugs. Whatever the reason, the FDA says the risk appears greatest in the early weeks of treatment or right after a dose is increased or decreased.
My advice: When anyone you know—but particularly a young person—is taking an antidepressant, be alert for warning signs, including worsening depression…talk of suicide…sleeplessness…agitation…and social withdrawal.
• Varenicline (Chantix). This prescription pill can help some people quit smoking. But for years, the FDA has required this medication to be labeled with a black-box warning alerting users that the drug has been linked with serious mental health problems, including suicidal thinking and behavior.
In 2016, citing new data, the FDA removed the strong warning, saying that the benefits of using Chantix to quit smoking outweighed the possible mental health risks and that those risks appear to be lower than previously suspected.
However, the risk for suicidal thinking continues to be mentioned on the manufacturer’s website.
What may not be brought to your attention: Some of the best smoking-cessation tools, including nicotine-replacement products such as gums and patches, are available without a prescription and have not been linked to suicidal thinking. In-person and telephone counseling (call 800-QUIT-NOW) also can help some smokers.
My advice: If you’re uneasy about taking Chantix, try one of the other approaches mentioned above. But do stay resolved to quit smoking!
The list of widely used medications linked to suicidal thoughts or actions also includes the OTC allergy drugs cetirizine (Zyrtec) and levocetirizine (Xyzal)…the acne drug isotretinoin (Accutane)…the nerve pain drug pregabalin (Lyrica)…and a variety of medications, including carbamazepine (Tegretol) and divalproex (Depakote), that are used to treat seizures. Studies differ on which seizure medications are associated with the risk, so the FDA requires warnings on all of them.
Good rule of thumb: If you don’t feel “right” when starting any new medication or a new dose of a medication, talk to your pharmacist, physician or other health-care provider. You also can read about the possible side effects of any medication at FDA.gov—search “Index to Drug-Specific Information.”
Critically important: If you or someone you know is having suicidal thoughts, immediately call your doctor…go to a hospital emergency room…or call the confidential and toll-free National Suicide Prevention Lifeline at 800-273-TALK (8255). Help is available!
