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Myth: Medicines Cause Suicidal Behavior

No clear evidence has emerged for any generally approved medication that it causes suicidal ideation in the general public. Because of a study for an antidepressant where there was a 4% indication of suicidal ideation with the target drug and 2% with placebo, the FDA decided to issue a warning. Note that this study didn’t experience any suicide-related death. This study and its design have been widely challenged in the twenty years since the first issuance of the warning, but the warning remains.

Fact: Some Medications Have a Warning for Increasing Suicidal Thoughts

It’s true that antidepressant medications have a “black box” warning, as required since 2004 by the US Food and Drug Administration, indicating the potential to increase suicidal thoughts and ideation. These warnings were triggered by very low, and statistically insignificant, rates of suicidal ideation during a trial that wasn’t detected prior to the start of the study.

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While many have challenged the efficacy of antidepressant medications due to their low differential effectiveness compared to placebo, some believe the medications contribute greatly to their lives. (See Warning: Psychiatry May Be Hazardous to Your Mental Health for some of the criticisms.)

Evidence

The evidence for issuing the warning was very weak both in magnitude and in terms of the reliability of the original design. There may be some people in which suicidal behavior is increased but it doesn’t appear that there’s a clear indication that this is the case.

In Support of the Myth

Suicidality in Children and Adolescents Being Treated with Antidepressant Medications (2004-2018)

Required black box warnings.

To Refute the Myth

"Effect of the FDA Black Box Suicidality Warnings for Antidepressants on Suicide Rates in the USA" (2023)

The issuance of the FDA black box warning presumably changed prescriber and consumer behavior; however, no behavior change point was observed in the data.

"Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and declines in Depression Care" (2020)

An increase in suicide deaths after the black box warning was added to medications, presumably due to decreased prescriptions of the impacted drugs.

"The FDA 'Black Box' Warning on Antidepressant Suicide Risk in Young Adults: More Harm Than Benefits" (2019)

Questions whether the result of the warning is undertreatment.

"Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to the US Food and Drug Administration" (2009)

Indicates that age dependent effects may be in place leading to strong positive impacts in older age and mixed effects at younger ages.

Unclear or Mixed Support

"Antidepressants and the FDA’s Black-Box Warning: Determining a Rational Public Policy in the Absence of Sufficient Evidence" (2012)

The title clearly indicates a lack of sufficient evidence.

Learn more about suicide myths – and the truths behind them – by following the links below.