Singulair has been shown to encourage suicidal ideation in people who are already prone to it. Having certain mental health conditions can raise this risk.

While people can experience suicidal thoughts for a variety of reasons, sometimes medications can make this situation more likely to occur. Most people wouldn’t associate asthma or regulating the condition through medication with a risk of suicide or even suicidal ideation (the action of thinking about suicide).

However, over the years, one popular asthma medication has been linked with an increase in suicidal ideation in adults. If you have asthma, it’s important to understand the risks as well as safer alternatives that you can take.

If you have asthma as well as depression or other mental health concerns that can increase your risk of suicidal ideation, you need to know that medication could be causing these thoughts and that help is available.

You’re not alone

If you’re experiencing suicidal thoughts, know that you’re not alone.

In the United States, you can dial or text 988 to be connected to someone from the Suicide & Crisis Lifeline who can talk or chat with you and provide help. This is a free service that’s available 24 hours a day, 7 days a week, as part of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Alternatively, you can also visit to chat with trained professionals and research additional support options.

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The short answer is, yes. There’s a medication that has been linked with an increase in mental health side effects.

However, research has suggested that the increased risk is most prevalent in people who were already experiencing mental health concerns. It’s also important to note that the severity of a person’s asthma can also influence the intensity of mental health side effects.

A 2020 study looked at the link between depression, suicidal motivation (SM), and suicidal ideation (SI) in people with asthma. The cross-sectional study that followed 1,358 adults consisted of people with asthma — but with a mix of well controlled and poorly controlled cases. Some of the study’s findings are:

  • Of all participants, 222 had depression, 331 had SM, and 73 had SI.
  • Meanwhile, 138 people had mild depression with SM, and just 14 with mild depression and SI.
  • When the researchers adjusted the participant figures to solely look at people who also had severe asthma (SA), they found that the chance of depression increased by 53%.

The study also found that people who felt they had low social support for their condition or that their asthma was poorly managed with few resources to treat it had a higher chance of experiencing depression.

But, even people with mild asthma could be at risk of experiencing depression, SM, and SI.

What asthma medications can cause suicidal ideation?

In March 2020, the Food and Drug Administration (FDA) issued a warning for the asthma and allergy drug montelukast, which is marketed under the brand name Singulair as well as in generic form.

Specifically, the FDA noted that it had received continued reports of increases in depression, agitation, sleeping problems, and even suicidal thoughts in people who were taking the medication.

While montelukast already contained a warning about potential mental health-related side effects, the FDA now requires a black box warning on the packaging.

The FDA also advised doctors to avoid prescribing this medication to people with mild asthma symptoms and offer alternative options. The FDA recommends that before prescribing Singulair or a generic version of it, doctors ask for patient history, specifically if there’s a history of psychiatric conditions and suicidal tendencies in particular.

If you’re experiencing suicidal ideation and are on Singulair or a similar medication, you should know that your medications could be influencing your train of thought. You should call your doctor as soon as you can to let them know what you’re going through and ask if you should discontinue your medication.

Remember to treat yourself with compassion, and reach out to your support system. While mental health conditions can sometimes have a stigma attached to them, they’re also common. Reach out to a friend, family member, trusted religious leader, or seek counseling to help you work through these feelings.

Crisis lines

Wherever you’re coming from, there’s a crisis line to talk you through it:

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Suicidal ideation can happen to anyone. While a history of mental health conditions can be a warning sign, not every person who experiences suicidal thoughts fits that description. Paying attention to your loved ones, and looking for significant behavioral changes can be a sign that something is wrong.

Common warning signs include:

  • becoming withdrawn or isolated
  • extreme anger or discussing revenge
  • an increase in drug or alcohol use
  • feeling helpless, trapped, or being a burden to others
  • excessive or minimal sleep
  • extreme changes in mood, agitation, or anxiousness

Note that if you think an adult is experiencing suicidal thoughts and is currently taking Singulair, you should encourage them to stop taking the medication and talk with their doctor. If they’re your child, stop giving them the medication and reach out to your clinician to determine alternative prescriptions.

If someone you know is having suicidal thoughts, the first thing to do is remain calm. Make sure they’ve had a good meal and try to engage them with a favorite hobby or comfort movie. Listen to how they feel without judgment, and help them see that they have people around to support them. Remind them that many people go through this and grow past it.

Encourage them to get professional help, go with them to a hospital or sit with them while they call a crisis line. You can also call the line yourself to get more advice.

Most directives encouraging clinicians to offer alternative medications to Singulair tend to focus on alternate over-the-counter (OTC) allergy medications. This is because Singulair treats both asthma and allergies.

If Singulair is no longer a viable option for people with asthma, a few prescription alternatives exist.

One option can be zafirlukast, which is marketed as Accolate and can be prescribed for those ages 5 and up. In studies, it’s shown to be just as effective as Singulair. Accolate, which is usually cheaper than Singulair, tends to have fewer side effects — and lacks the FDA black box warning. However, there’s still a precaution to watch for suicidal ideation.

Other proven alternatives to Singulair include:

  • Nasalcrom (age 2 and up)
  • Advair (age 4 and up)
  • Qvar (age 4 and up)
  • Symbicort (age 6 and up)
  • Zyflo (age 12 and up)

Not every person with asthma who takes Singulair will experience suicidal thoughts. But for people with a history of mental health concerns, or who experience changes in mood when taking this medication, knowing why it’s happening is important.

Remember that your physician is there to help you and can provide an alternative medication if you experience problems.

More importantly, if you’re experiencing suicidal thoughts, know that you’re not alone. Call or text 988 or visit to get immediate help. Remember, this resource is always free, and help is available 24 hours a day, 7 days a week.