Antidepressants and suicide risk

Concerns have been raised about an increased risk of suicidal thoughts and acts when people first start taking antidepressants. The concern has mainly been about selective serotonin reuptake inhibitors (SSRIs).

Suicidal thoughts and acts are a common symptom of depression, and often someone is at their lowest point when they first start taking an antidepressant. It can also take a few weeks for an antidepressant to work. This makes it difficult to assess whether people who think about suicide when they first start taking an antidepressant do so because of the medicine or the depression.

Although this is a difficult issue to give a definitive answer about, analysis of a large number of studies shows that there may be a small increase in suicidal thinking or behaviour in children, adolescents and young adults when they first start taking an antidepressant. The age-cut off for this increased risk seems to be about 25 years.

In adults aged 25–64 years, antidepressants seem to have no effect on suicidal behaviour but may reduce suicidal thoughts. In adults aged 65 years and over, antidepressants seems to reduce the risk of both suicidal thoughts and suicidal behaviour.

If there is a risk, why would this happen?

One possible explanation is that antidepressants increase a person’s energy before they begin to improve mood. This could make a depressed person more capable of acting on suicidal thoughts before the medicine improves their mood.

Children, adolescents and antidepressants

Antidepressants have only a small role in treating children, and they should be used only under the supervision of a child psychiatrist. Antidepressants should be prescribed for adolescents only by doctors with training in this area who are very familiar with the side effects and are able to provide close monitoring for suicidal thinking, particularly in the first four weeks.

What’s the bottom line?

If you have any suicidal thoughts, get help straight away. It’s a good idea to write down an advance action plan with your doctor, for example, a list of five phone numbers to call; this allows some back-up in case you can’t get through to the first people you call.

If you are caring for someone starting treatment with an SSRI medicine, keep a close eye on them for worsening symptoms in the first few weeks, and call their doctor if you are worried.

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