Drugs used to treat depression are called antidepressants. All antidepressants have a black box warning from the U.S. Food and Drug Administration (FDA). The FDA is the U.S. agency that reviews and approves medications, and a black box warning is the most serious warning a drug can have.
The black box warning for antidepressants indicates that the drugs have the risk of causing suicidal thoughts and actions in children, teenagers, and young adults ages 18 to 24 years. The risk is higher within the first two months of treatment with an antidepressant medication. This is when most suicidal thoughts are likely to occur.
If you or a loved one is having thoughts of suicide while taking antidepressant medication, it may or may not be because of the drug. Depression or other mental health conditions increase the risk of suicide on their own. This risk is present whether you take a drug to treat depression or not. It’s also crucial to keep in mind that recent studies show more benefits than risks of using antidepressants to treat depression or anxiety. This is true even in children, teenagers, and young adults.
So, even though antidepressants have a black box warning, you and your doctor should consider your particular risks and benefits. The suicide warning can be alarming, but don’t stop taking your prescriptions without discussing it with your doctor first.
The exact reason for this risk is unknown, but there are two theories. Some past studies show that children who start antidepressants may become more irritated and violent. These new symptoms could lead to suicidal thoughts or actions. Another explanation has to do with the idea that the brain is not fully developed until around 24 years of age. People older than 24 years tend to limit their risk-taking behaviors and have more mature, less impulsive thinking. So, medications that alter brain chemistry may affect people 24 years of age and younger in a way that is not yet fully understood.
The risk of suicide from antidepressants in people older than 24 years does not appear to be increased. What’s more, these drugs may even lower the risk of suicide in adults 65 years of age and older, according to the FDA. Keep in mind, though, that depression on its own raises the risk of suicide, even if you’re not taking an antidepressant.
If you’re taking drugs to treat depression, watch out for any unusual changes in your behavior, mood, feelings, or thoughts. If you’re a parent or caregiver of a child or young adult taking these drugs, watch for these effects. Pay extra close attention for these changes during the first few of months of treatment or when your doctor changes the dosage of your drug. The risk for suicide is higher during these times.
These symptoms may be warning signs of suicidal thoughts or an attempt to commit suicide:
- anxiety, nervousness, or restlessness
- sleeping problems
- irritated, aggressive, violent, or angry feelings
- impulsive behavior
- feeling more excited and active than usual
- worsened depression
- panic attacks
Tell your doctor right away if you have any of these symptoms.
Your doctor will discuss the risk of suicidal thoughts and actions with you before you start a drug treatment. Make sure you fully understand the risk of suicide before you or your child starts taking an antidepressant. It may be a good idea to ask your doctor about other options for treating depression besides drugs. Other treatments, such as therapy and exercise, do not have this risk. If you’re interested, check out these options for beating depression naturally.
If you do take an antidepressant, you can do several things to decrease your risk of suicide. Most of these options involve careful use and good communication with your healthcare provider.
The best way to prevent suicide is to pay careful attention to symptoms. If you have any thoughts of harming yourself and any sudden changes in your behavior or mood, tell your doctor or call 911 or your local emergency services right away.
Make sure you keep up with all of your checkups, too. Your doctor will watch you closely and look for signs of an increased risk of suicide. They will also make sure your depression treatment is working for you.
Some drug interactions may also increase your risk of suicide. To decrease your risk, tell your doctor about all other drugs that you take before starting an antidepressant. This way, your doctor can watch for dangerous drug interactions.
If you have any suicidal thoughts or any sudden changes in your behavior, mood, or feelings, call your doctor immediately. Your doctor can help in several ways and offer resources to help. If the threat of suicide is immediate, call for help right away. You can call 911 or the toll-free National Suicide Prevention Lifeline at 1-800-273-8255(TALK).
In terms of your medication, your doctor may change or stop your antidepressant treatment. If your doctor decides to stop your treatment, you may need to take smaller doses over several weeks before fully stopping the drug. Tapering off your dosage can help minimize unpleasant withdrawal symptoms, such as anxiety, trouble sleeping, or a return of depressive symptoms. You should not suddenly stop taking your medication without speaking to your doctor first.
All antidepressants come with the suicide risk warning. If you’re unsure if you’re taking an antidepressant, see if it’s listed here. You can also call your doctor to learn more.
Alpha-2 antagonists act on certain molecules in your brain. Specifically, they increase the chemicals serotonin and norepinephrine. This helps to ease symptoms of depression. These drugs include:
- mirtazapine (Remeron, REMERON SolTab)
Dopamine/norepinephrine reuptake inhibitors
These drugs work by increasing the levels of dopamine and norepinephrine in your brain. These chemicals play a role in depression. Increasing the levels of these substances helps treat depression. These drugs include:
- bupropion hydrochloride (Budeprion, Wellbutrin, Zyban)
- bupropion hydrobromide (Aplenzin)
Monoamine oxidase inhibitors (MAOIs)
MAOIs work by increasing chemicals in your brain called amines. It’s unclear how this action helps to treat depression. These drugs include:
- isocarboxazid (Marplan)
- phenelzine sulfate (Nardil)
- selegiline (Emsam)
- tranylcypromine sulfate (Parnate)
Selective serotonin reuptake inhibitor (SSRIs)
These drugs work by increasing the amount of serotonin in your brain. This helps alleviate symptoms of depression. These drugs include:
- citalopram hydrobromide (Celexa)
- escitalopram oxalate (Lexapro)
- fluoxetine hydrochloride (Prozac, Sarafem, Symbyax)
- fluvoxamine maleate (Luvox CR)
- paroxetine hydrochloride (Paxil)
- paroxetine mesylate (Pexeva)
- sertraline hydrochloride (Zoloft)
- vortioxetine (Trintellix)
- vilazodone (Viibryd)
Serotonin/norepinephrine reuptake inhibitor (SNRIs)
These medications work by increasing serotonin and norepinephrine levels in your brain. This helps improve depression symptoms. These drugs include:
- desvenlafaxine succinate (Pristiq)
- duloxetine hydrochloride (Cymbalta)
- levomilnacipran (Fetzima)
- milnacipran hydrochloride (Savella)
- venlafaxine hydrochloride (Effexor)
Serotonin reuptake inhibitor/antagonists
These drugs work by increasing serotonin and norepinephrine in your brain. These chemicals play a vital role in depression. Increasing the chemicals helps ease your symptoms. These drugs include:
Tricyclic antidepressants increase norepinephrine and serotonin levels. This helps improve your depression symptoms. These drugs include:
- amitriptyline hydrochloride
- clomipramine hydrochloride (Anafranil)
- desipramine hydrochloride (Norpramin)
- doxepin hydrochloride (Silenor)
- imipramine hydrochloride (Tofranil)
- imipramine pamoate (Tofranil-PM)
- maprotiline hydrochloride (Ludiomil)
- nortriptyline hydrochloride (Pamelor)
- protriptyline hydrochloride (Vivactil)
trimipramine maleate (Surmontil)
Your doctor is one of your best resources. Ask your doctor about your risk of suicide from your medication. The FDA also regularly posts safety updates about drugs. You can check for new information about the suicide risk from antidepressant use at the FDA Consumer Update page.
This information is intended as an educational piece and should not be used as a source for treatment decisions. The list of antidepressant drug classes that have a black box warning for suicide risk is current as of July 2016.