From the FDA Drug Label
PRECAUTIONS General Suicide As with other psychotropic medications, the usual precautions with respect to administration of the drug and size of the prescription are indicated for severely depressed patients or those in whom there is reason to expect concealed suicidal ideation or plans Panic disorder has been associated with primary and secondary major depressive disorders and increased reports of suicide among untreated patients.
The use of alprazolam (Xanax) may be associated with an increased risk of suicide in patients with severely depressed patients or those with panic disorder. It is essential to take precautions when administering the drug, especially in patients with a history of depression or suicidal ideation. Key considerations include:
- Severely depressed patients require careful monitoring and precautions to minimize the risk of suicide.
- Panic disorder has been linked to an increased risk of suicide, particularly if left untreated.
- Patients should be closely monitored for signs of suicidal ideation or plans 1.
From the Research
Xanax (alprazolam) can increase suicide risk, particularly in individuals with depression or suicidal thoughts, and healthcare providers should carefully evaluate patients for depression and suicide risk before prescribing Xanax, considering alternative treatments for patients with significant suicide risk. The medication can worsen depression symptoms and reduce inhibitions, potentially making someone more likely to act on suicidal thoughts. This risk is highest during initial treatment, dose changes, or discontinuation. According to a study published in 2017 2, benzodiazepines, including Xanax, appear to cause an overall increase in the risk of attempting or completing suicide, with possible mechanisms including increases in impulsivity or aggression, rebound or withdrawal symptoms, and toxicity in overdose.
Key considerations for managing patients on Xanax include:
- Monitoring closely for mood changes, increased depression, or suicidal ideation, especially during the first few weeks of treatment 2
- Being aware that the risk is greater in adolescents and young adults
- Informing family members about watching for warning signs like talking about death, giving away possessions, or sudden mood improvements which can sometimes indicate a suicide decision has been made
- Never stopping Xanax suddenly as withdrawal can worsen these symptoms
- Considering alternative treatments for patients with significant suicide risk, as suggested by a study published in 2022 3, which emphasizes the importance of a thorough suicide risk assessment and appropriate management in primary care settings.
It's also important to note that while selective serotonin reuptake inhibitors (SSRIs) may offer short-term protection against suicidal ideation, as found in a 2024 study 4, the long-term effectiveness of these medications in mitigating suicidal ideation and preventing suicidal behaviors is limited, highlighting the need for careful evaluation and management of patients with suicidal risk.