Does Olanzapine (Zyprexa) have a risk of increasing suicidal ideation?

From the Guidelines

Yes, Zyprexa (olanzapine) carries a suicide risk, particularly in younger adults and adolescents. The FDA has issued a black box warning for all antipsychotic medications, including Zyprexa, regarding increased suicidal thoughts and behaviors, especially during the initial treatment period or with dosage changes. Patients starting Zyprexa should be closely monitored for worsening depression, suicidal thoughts, unusual behavior changes, agitation, or panic attacks, particularly during the first few months of treatment or after dose adjustments. The risk appears higher in people under 25 years old. This suicide risk stems from complex interactions between the medication's effects on brain chemistry and the underlying mental health condition being treated. Paradoxically, while Zyprexa treats conditions that may include suicidal thoughts, the medication itself can temporarily increase these thoughts in some individuals, especially early in treatment. Anyone taking Zyprexa should report concerning mood changes to their healthcare provider immediately, and family members should be alert for warning signs of suicidal behavior, as supported by the guidelines from the American College of Physicians 1. Additionally, non-pharmacologic interventions such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have been shown to reduce suicidal ideation and behavior, and may be considered as part of a comprehensive treatment plan 1. It is essential to weigh the benefits of Zyprexa against the potential risks and to closely monitor patients, especially during the initial treatment period, to minimize the risk of suicidal thoughts and behaviors. Key considerations for clinicians include:

• Close monitoring of patients starting Zyprexa, especially during the first few months of treatment or after dose adjustments
• Regular assessment of patient status, therapeutic response, and adverse effects of antidepressant therapy
• Consideration of non-pharmacologic interventions such as CBT and DBT as part of a comprehensive treatment plan
• Discussion of adverse event profiles with patients before selecting a medication, as recommended by the American College of Physicians 1.

From the FDA Drug Label

1. 2 Suicide The possibility of a suicide attempt is inherent in schizophrenia and in bipolar I disorder, and close supervision of high-risk patients should accompany drug therapy. Prescriptions for olanzapine should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.

Yes, Zyprexa has a suicide risk associated with it, particularly in patients with schizophrenia and bipolar I disorder. Close supervision of high-risk patients and careful management of prescriptions are recommended to reduce the risk of overdose 2.

From the Research

Zyprexa and Suicide Risk

• The provided studies do not directly mention Zyprexa, but they discuss the relationship between antidepressants, including selective serotonin reuptake inhibitors (SSRIs), and suicidal behavior.
• A study from 2009 3 found that SSRIs increase the risk of suicidal ideation and attempts in children, adolescents, and young adults, but not in adults.
• A 2022 study 4 found that SSRI treatment may reduce the risk of suicidal behavior in both youths and adults.
• Another 2022 study 5 found that antidepressant exposure, including SSRIs, increases the risk of suicidal ideation and attempts in children and adolescents.
• A 2004 study 6 found that the risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first 1 to 9 days.
• A 2012 study 7 found that fluoxetine and venlafaxine decrease suicidal thoughts and behavior for adult and geriatric patients, but no significant effects of treatment on suicidal thoughts and behavior were found for youths.

Key Findings

• The relationship between antidepressants and suicidal behavior is complex and may vary depending on age and other factors.
• Some studies suggest that SSRIs may increase the risk of suicidal ideation and attempts in children and adolescents, while others suggest that they may reduce the risk of suicidal behavior in both youths and adults.
• The risk of suicidal behavior may be increased in the first month after starting antidepressants, especially during the first 1 to 9 days 6.