From the Guidelines
If you're experiencing suicidal thoughts while taking SSRIs, contact your healthcare provider immediately - do not stop the medication abruptly on your own. Paradoxically, some people, especially young adults and adolescents, may experience increased suicidal thoughts during the first few weeks of SSRI treatment (such as fluoxetine, sertraline, escitalopram) 1. Your doctor might need to adjust your dosage, switch to a different medication, add another medication temporarily, or in severe cases, discontinue the SSRI. During this time, increased monitoring and support are crucial. The risk of suicidal thoughts typically occurs early in treatment because antidepressants can increase energy and motivation before improving mood, potentially giving someone the energy to act on existing suicidal thoughts. Abruptly stopping SSRIs can cause withdrawal symptoms and worsen depression, so any medication changes should be supervised by a healthcare professional. If you're in immediate danger, go to an emergency room or call a crisis hotline right away.
Some key points to consider:
- The pooled absolute rates for suicidal ideation across all antidepressant classes and all non-OCD anxiety indications have been reported to be 1% for youths treated with an antidepressant and 0.2% for youths treated with a placebo 1.
- Close monitoring for suicidality is recommended by the FDA, especially in the first months of treatment and following dosage adjustments 1.
- Alternative treatments, such as ketamine infusions, may be beneficial for some patients with major depression who have suicidal ideation 1.
- Lithium may reduce the risk for suicide in patients with unipolar depression or bipolar disorder 1.
- Cognitive behavioral therapy (CBT) can be an effective non-pharmacologic treatment for reducing suicidal ideation and behavior 1.
It's essential to work closely with your healthcare provider to determine the best course of treatment and to ensure your safety while taking SSRIs.
From the Research
Suicidal Thoughts with SSRIs
- The relationship between SSRIs and suicidal thoughts is complex, with some studies suggesting a potential link, particularly in younger age groups 2, 3, 4.
- A study published in 2008 found that SSRIs carry a small risk of inducing suicidal thoughts and suicide attempts in individuals under 25 years old, with the risk decreasing after the age of 30-40 years 2.
- Another study from 2012 noted that while SSRIs may cause worsening of suicidal ideas in vulnerable patients, the current evidence does not provide a clear relationship between their use and risk of suicidality in adults 3.
- However, in children and adolescents, there appears to be an increased risk of suicidal ideations and attempts associated with SSRIs 3, 4.
Management of Suicidal Thoughts with SSRIs
- Clinicians are advised to maintain a close follow-up during the initial treatment periods and remain vigilant of the risk of suicidal thoughts and behaviors in patients taking SSRIs 3.
- The decision to stop SSRIs due to suicidal thoughts should be made on a case-by-case basis, taking into account the individual patient's risk-benefit profile and the potential consequences of discontinuing treatment 2, 3.
- A study published in 2024 analyzed pharmacovigilance data and found that psychiatric adverse drug reactions, including suicidal ideation and attempts, were more frequent in women and in patients aged 18-64, with notable incidence in the 0-17 age group 5.
Age-Dependent Risk of Suicidal Thoughts with SSRIs
- The risk of suicidal thoughts and behaviors associated with SSRIs appears to be age-dependent, with younger individuals being at higher risk 2, 3, 4.
- A study from 2009 found that treatment with SSRIs does not increase the risk of suicide in adults, but it is difficult to make a firm pronouncement about the effect of SSRIs on suicidal behavior in this age group 4.
- In contrast, children, adolescents, and young adults being treated with SSRIs are at an increased risk of attempted suicide 4.