Antidepressants and Suicide

The Centers for Disease Control and Prevention (CDC) states that an estimated one in 10 adults in the U.S. suffers from depression, with symptoms including a constant feeling of sadness and emptiness, a loss of interest in activities, low energy, fatigue, aches and pains, and a sense of hopelessness. Antidepressants, which first came on the market in the 1950s, offer relief for many patients, helping them to get back into their active lives – but like all medications they come with risks.

Some patients who take a certain class of antidepressants—called selective serotonin reuptake inhibitors (SSRIs)—may experience minor side effects such as nausea, dry mouth, headache, weight gain, drowsiness, diarrhea, or insomnia. It wasn’t until the early 2000s, however, that a new, very serious antidepressant side effect emerged—suicidal thoughts and tendencies.

Throughout the last decade, scientific studies and physician reports have linked SSRI antidepressants and suicide, prompting the FDA to require updated warnings on the product labels, but not until after many patients were unknowingly exposed to the risk.

Medical studies link antidepressants and suicide

In several clinical trials and scientific study reviews, patients who were taking SSRI antidepressants went on to think about, attempt, or commit suicide.

Examples of research on the relationship between antidepressants and suicide:

• British Medical Journal (BMJ) 1995: Scientists reviewed medical records for over 172,000 people who were taking at least one prescription for antidepressants between January 1988 and February 1993. Results showed that about 143 of these patients committed suicide, with the overall rate estimated to be 8.5 per 10,000 people each year.  Risks were higher in men than women, and in people who had taken several different antidepressants.
• Journal of the American Medical Association (JAMA) 2004: Researchers reviewed 159,000 patients taking one of four antidepressant drugs, and found that the risk of suicidal behavior was increased in the first month after starting antidepressants, especially in the first 1-9 days.
• BMJ 2004: Scientists note that data from pediatric trials suggest that SSRIs are associated with an increased risk of suicidal behavior.
• BMJ 2005: A study compares patients taking SSRI antidepressants with those taking tricyclic antidepressants and found that the risk of suicide or non-fatal self-harm in those taking SSRIs was greater than those taking tricyclic antidepressants.
• BMJ 2005: A systematic review of randomized controlled trials, including over 87,000 patients, found that there was an association between SSRI antidepressants and suicide.
• Arch Gen Psychiatry 2006: A cohort study examines patients hospitalized because of a suicide attempt between 1997 and 2003, and concludes that the use of antidepressants “was associated with a markedly increased risk of attempted suicide.”
• British Journal of Psychiatry 2006: A meta-analysis showed that antidepressants may cause a short-term risk of self-harm or suicidal events in children and adolescents with major depressive disorder.
• BMJ 2007: Researchers compared the risk of suicide in 219,000 adults using various antidepressants, and found that venlafaxine (Effexor) was consistently associated with a higher risk of suicide compared with citalopram (Celexa), fluoxetine (Prozac), and dothiepin (Dothep).
• BMJ 2009: A meta-analysis of 372 double blind, randomized placebo-controlled trials reveals that risk of suicidality associated with the use of antidepressants is strongly age dependent, with those 25 and younger at the highest risk.

SSRI black box warning concerning suicide

Because of these and other studies, in 2003, the FDA released a “dear doctor” letter, warning physicians that research had linked SSRIs with an increased risk of suicide and suicidal behavior in children and adolescents. In September 2004, a federal advisory panel voted 15 to 8 that the FDA should mandate that antidepressants carry a black box warning concerning the risk of suicide in children and adolescents.

In October 2004, the agency did just that, requiring all manufacturers of antidepressants to include a black box warning on their product labels alerting physicians and patients to link between antidepressants and suicide in children and adolescents. In 2006, the FDA recommended that children not take Zoloft, since it was found to increase suicidal tendencies in one out of 50 young patients.

In May 2007, federal regulators required an update to FDA antidepressant warnings to include young adults age 18 to 24. Among those SSRIs and antidepressants were:

• Zoloft
• Celexa
• Cymbalta
• Effexor
• Fluvoxamine
• Lexapro
• Paxil
• Pexeva
• Sarafem
• Symbyax
• Prozac

Lawsuits filed over antidepressants and suicide

Many patients and their family members who were affected by antidepressants and suicide filed lawsuits in the hopes of recovering damages in court. Among the claims made in these lawsuits were failure to warn and defective design. Some notable cases included:

• Zoloft: In May 1998, comedian Phil Harman’s wife, Brynn, returned home from a night out with friends and shot her sleeping husband three times, then four hours later, lay down next to his body and killed herself. The family filed a lawsuit against Zoloft manufacturer Pfizer, claiming the outburst was caused by the drug. The family won the case, receiving an out-of-court settlement with Pfizer.
• Prozac: In February 1997, Patricia Williamson of Texas stabbed and slashed herself more than 100 times in the bathtub. She had started taking Prozac six days earlier. She died the next day in the hospital. The family negotiated a settlement with drug maker Eli Lilly out of court.
• Paxil: A federal jury in Wyoming awarded $6.5 million in 2001 to relatives of Donald Schell, who shot and killed his wife, daughter, granddaughter, and himself after taking Paxil for two days.
• Zoloft: When a young boy only 11 years old hung himself in October 2002, his parents filed a claim against Pfizer, alleging that Zoloft had prompted the violent action. The boy had been taking the antidepressant for only a month before his suicide. His parents settled out of court.
• Paxil: In a settlement with the U.S. Justice Department in 2012, GlaxoSmithKline agreed to pay $3 billion in fines for marketing drugs for unapproved uses, and failing to report drug safety information to the FDA. Among other activities, the company was accused of offering kickbacks to doctors and sales representatives to push the drug Paxil for use in teens under 18, even though the SSRI was not approved for that age group. In addition, a government probe discovered that Paxil and other antidepressants were no more effective than a placebo in treating depression in kids.