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Can Antidepressants Cause Depression and Suicidality?

Antidepressants are supposed to help treat depression, right? In cases where nothing else has worked for a person to manage their depression, an antidepressant is considered a clinically effective treatment option. Millions of people are put on antidepressants and in the United States, it is estimated that one out of every five people or so are on a psychiatric medication.

Although these can drugs prove to be a life saver for many, other people do not respond very well. In some cases people actually experience drastic increases in their depression as opposed to relief from it. When depression is increased as a result of taking a drug designed to treat it, this may leave the individual hopeless in their quest to manage their symptoms.

Can Antidepressants Cause Depression?

Antidepressants can cause depression a couple of different ways: while you are taking them and after you have come off of them. The depression that you experience while taking them is a result of your brain chemistry being altered from the drug. In some cases, a surplus of serotonin (from the medication) could cause your depression to become worse.

Most major pharmaceutical companies market the fact that people with depression have low serotonin, but they don’t really know for sure. They just make that claim because many people respond well to SSRI’s. The depression you experience after your treatment is a result of abnormally low levels of neurotransmitters (e.g. a chemical imbalance) as a result of the treatment.

During treatment

Can antidepressants cause a person to become increasingly depressed while taking them? Ironically the answer to that question is “yes.” I know this not only from other people’s experiences, but from my own personal experience. I only experienced antidepressant relief from a couple of medications that I was on in the past. All other medications made my depression increase in severity.

Post-treatment (Withdrawal)

Following treatment with an SSRI, you may notice that you become increasingly depressed. When you withdraw from the drug, your serotonin (and other neurotransmitters) are imbalanced. I wrote an article about antidepressants causing a chemical imbalance – which further increases depression. Some people are shocked that a drug used to treat depression can result in a person feeling even more depressed after treatment than they did before they were treated.

Antidepressants Cause Suicidality

There is clear evidence that taking antidepressants can lead to increases in suicidal thoughts and behaviors. This was found to be especially prominent among children and adolescents. Further research indicated that adults taking these drugs had just as much of a risk as younger populations to experience suicidal thoughts. Additionally it has been discovered that class of antidepressant drug does not play a role in increasing suicide risk.

In other words, people taking SSRI’s have the same risk of developing suicidal thoughts as individuals taking TCA’s. Another problem associated with antidepressants is that in some cases, they take a long time to work. The fact that people may experience increases in suicidal thoughts before the drugs “work” can further complicate this form of treatment.

Despite the fact that antidepressants causing a person to develop suicidal thoughts is “up for debate,” my personal experience and countless others are not “up for debate.” I have taken nearly every SSRI medication available as well as SNRI’s and TCA’s and in my experience, most of them that didn’t work, lead me to develop suicidal thinking. It is just a fact that these drugs can cause people to become increasingly suicidal.

In 2006, researchers brought up whether suicidality as a result of antidepressant treatment outweighed any beneficial effects of the drug. Although this suggested that doctors provide better information for patients regarding risk of suicidal thoughts, most doctors do not inform people about this possibility. Most people find out about this effect when they notice that they actually feel more suicidal on antidepressants than being off of them.

Keep in mind that nearly all of these drugs have a “black box” warning – meaning an extreme word of caution regarding the fact that antidepressants may lead you to become increasingly suicidal. This warning was applied to all adolescents and young adults up to the age of 24. With the evidence demonstrating that suicidality as a result of antidepressant treatment affects adults just as much as adolescents, this warning should also apply to them.

How do we know the antidepressants cause increased depression and suicidality? Because people have committed suicide with no prior history of mental illness just participating in “trials” for various antidepressants. In other words, it is the drugs that have lead people to take their own life.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198229/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC557941/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453113/
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/17143567/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824975/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799109/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC193979/
  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195160/

What to do if antidepressants make you feel more suicidal?

The best thing you can do for yourself if the medication you are on is making you feel more suicidal is to gradually stop taking it. It isn’t rocket science that people have adverse reactions to medications. Some people respond well to antidepressants, others don’t. There have been cases of people committing suicide after taking less than a week’s worth of doses with no prior history of mental illness.

Consult your psychiatrist and/or pharmacist to talk about what you are experiencing while taking the drug. Most of them know people have adverse reactions and cannot cope with various side effects of these drugs. If you are feeling more suicidal than before you started taking the drug, it’s obvious that you aren’t responding well. What makes these medications difficult is the fact that they sometimes make people feel worse before they become beneficial.

However, in the experiences of many people (including myself), the antidepressants that work tend to work pretty quickly. When I was taking Paxil, I noticed it working within a few days of taking it. Additionally, I had no increased suicidal thoughts during the period in which the drug worked. When the effect wore off and Paxil pooped out, I began feeling more suicidal than I had ever felt in my entire life.

The bottom line is that if you are feeling suicidal, you need to get help. This is a temporary feeling, likely exacerbated by the usage of your antidepressant medication. Know that you will recover from this feeling, and work towards trying to think positive about your future.

Antidepressants often require experimentation

The problem with antidepressant treatment is that you really don’t know how someone is going to respond. One drug class may be very effective for some people, but may have absolutely zero effects in other people. For this reason, it is important to test a variety of medication “classes” so that you know what works best for you. Since most people respond best to SSRI’s, these are the drugs typically prescribed first.

If you clearly experience increases in depression while on these drugs, your psychiatrist will likely switch medication classes. Depending on comorbid symptoms, your psychiatrist may consider trying a drug like Wellbutrin or Viibryd. They may also want to test out an SNRI or TCA (older antidepressant). Everyone responds differently to different classes of medications – each drug is unique in the way that it works.

Rules of thumb – Assuming you have explored all natural treatment options such as therapy, exercise, and socialization, there are a variety of drugs that will be thrown your way by psychiatrists.  Most of the drugs will be prescribed in a similar order to that outlined below.

  1. SSRI’s – This is the first line of treatment for depression in the United States. You will try multiple SSRI’s to determine if you respond to this class of drugs. Many people end up responding to one of these medications.
  2. Wellbutrin – If you don’t respond to an SSRI, the problem may not be low serotonin. You may have a better response by targeting low norepinephrine and dopamine instead of serotonin. Wellbutrin is a NDRI which means it targets neurotransmitters other than serotonin.
  3. SNRI’s – If you don’t respond well to an NDRI, a doctor may see if serotonin and norepinephrine reuptake inhibition is a better bet. In this case you may try a drug like Cymbalta, Effexor, or Pristiq to determine if either works.
  4. Viibryd – This is a newer medication that works on serotonin, but differently than most SSRI’s. If this medication doesn’t work well, you may end up getting put on a different class of medications altogether.
  5. TCA’s – Another class of antidepressants that can be explored is that of the Tricyclic class. These are older antidepressants, but have been proven to be effective in treating depression. Drugs in this class can range from having primary effects on serotonin to norepinephrine and in some cases, dopamine.
  6. MAOI’s – This class of antidepressants is least likely to be prescribed, but if all other drugs fail, this is the class that you may turn to. It is usually one of the last resort options, but worth checking out if your depression is refractory.
  7. Augmentation strategies: There are a variety of antidepressant augmentation strategies that can be used to help treat your depression. These strategies include hormone therapy, adding a psychostimulant (e.g. Adderall for depression), and/or something like an antipsychotic drug. Augmentation is typically used when all other monotherapy options (e.g. single drugs) have been explored.

Note: Although I am not a psychiatrist, I recommend always starting at the lowest possible dose of an antidepressant. Many times, these drugs are prescribed and/or found to be therapeutically effective at high dosages. If you are responding well to a medication at a low dose, it makes very little sense to further increase the dosage.

Antidepressants should always be considered a “last resort”

I have preached this consistently: antidepressant drugs should only be used after all other valid treatment options have been explored. Other treatment options include things like daily exercise, psychotherapy, dietary changes, supplementation, etc. If a person has gone through the ringer of natural cures for depression and has had no success, then tweaking neurotransmitters with psychiatric drugs is really the next best option.

These drugs are marketed as though they are always going to help someone who is depressed and/or struggling with suicidal thoughts. Clearly in some cases, they actually increase suicidal thinking and depression. Due to the fact that you risk feeling even more suicidal and more depressed on an “antidepressant” (the irony), you should not use one of these medications unless it is truly a “last resort.”

As someone that has been on these medications, I know exactly what it’s like to feel even more suicidal while on these drugs. Additionally, I fully understand how suicidal thoughts can plague people for extended periods of time even after they have been off of the drug. These create chemical changes in the brain and even though they are effective for about half the people that take them, many other people are left feeling even worse.

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{ 9 comments… add one }
  • Amethyst May 18, 2014, 10:39 am

    Yes, definitely. Last year I was on citalopram for 2 months. I developed constant 24/7 suicidal thoughts and akathisia along with many symptoms of seretonin syndrome. After coming off this, I was put on zoloft. This made my suicidality even worse, increased my akathisia and I had Parkinson’s like symptoms. I’m now off zoloft..came off too quickly because I didn’t know about slow tapering and was suffering terribly on the drug. I came off in a couple of months after bring on it for a couple of months. I now have extreme withdrawal to the extent that I’m mostly bed bound and still have the akathisia that started when I went on citalopram. I am still intensely suicidal. All this is because of the ssris. Before all this, I had anxiety, none of this.

    • Kay June 11, 2015, 4:40 pm

      How long did it take after you started taking citalopram to become more and more suicidal?

    • Helen Daff July 13, 2015, 2:31 pm

      Amethyst I don’t know if you’ll see this because it’s been a year since you posted. I would love to talk to you. The same thing happened to me. Its taken a long time but I am getting better and I know what will help you because I got the Parkinson’s like symptoms also.

  • Jonathan October 26, 2014, 1:21 pm

    I was off Zoloft for 6 weeks until 2 nights ago, having been on this and other SSRIs for 15 years. Two nights ago, I could no longer bear the agitation and dysphoria and FEAR that I would walk into oncoming traffic, I started taking 25 mg of Luvox. Two days later, I’m back to “normal”. I HAD to go off Zoloft because it gave me chronic GI problems and I’d lost 20 lbs.

    I currently feel better now that I have SOME DRUG in me, but fear that I am doomed to be hooked on these god forsaken pills for life. I lasted 47 days without SSRIs, but could no longer tolerate the torture. Megadose B6 helped with the akathisia, but not enough. The feelings of depersonalization, fear I’d never again be happy, emotional lability, all of them were too much to bear.

    If you ask me, Zoloft is the equivalent of legal, prescription Cocaine. On it, you’re energized — off it, you want to jump out a window.

  • Vanessa July 12, 2015, 1:09 pm

    Did the depression and suicidal feeling you had while on the antidepressants feel just like symptoms of the condition, in the way that you were aware it was the drug causing it? Or could it just feel like the original problem, but a bit worse? My 17 year old daughter (in the UK) is being given Mirtazapine (Remeron) since November last year, and has had no improvement in her depression/suicidal feelings even on the max adult dose…

    But is being continued on it for reasons that are beyond me. I feel that she is suffering from the side-effects (has attempted suicide twice now) but her psychiatrists can’t seem to see that, and she herself doesn’t seem to understand that the drug may be making things worse, and hindering any improvement from the supplements and therapies she’s also having.

  • Jackie Aumiller September 6, 2015, 7:17 pm

    Zoloft stopped working after many years and I was put on Cymbalta. For 2 weeks I was increasingly suicidal. I had never come so close to actually ending my life before this. Thankfully my psychologist and psychiatrist were quick to notice and soon I began taking Viibryd and Rexulti. Still having crying spells after 3 weeks so I will be speaking w/ my Dr and hopefully increasing the dosage as I did have one very joyful albeit ordinary day. Had not felt that good in decades. Depression is h.e.l.l. Find a good doctor!

  • Jeremy February 17, 2016, 11:36 pm

    Meds should never be given to someone for depression or anxiety these are normal things your brain needs to learn to cope with. If you are unable to cope… keep trying. Meds will only mask/increases the problem(s). Every doctor prescribing these meds should be hauled out-side and shot for malpractice… “Do no harm” my ass…

  • Nostradamus June 23, 2016, 7:46 pm

    @Jeremy – Your attitude towards depression and antidepressants seems somewhat one-sided and prejudiced to me. As severe depression and anxiety can have a huge impact on one’s functioning and motivation to a degree where it may be hard to do even basic tasks such as getting up in the morning and fulfilling your work or scholar duties, it can hardly be said that they represent, in all cases, is a “normal thing” and a state of mind you can “will your way out of”. Sometimes, depression is not only due to circumstances, but also to brain chemistry, resulting in a person having severe bad mood.

    Depressed people may also have adverse environmental conditions, but because of their depression and the often resulting lower motivation it is hard for them to fix those in that particular moment. Generally, people are not in total control of their emotions. At any given point of time, it may be impossible for you to decide to enter another mental state, e.g. to be happy, when you are sad, to be excited, when you are disappointed, to be loving, when you are full of anger.

    Same applies to depression. If things were as simple as your rather belittling attitude towards depression implies, people would not suffer from it. And antidepressants do help. They may not help everyone, and they have side effects. Even suicidal ideation. Yet, they can reduce in about 70% of patients depressive symptoms by at least 50% percent and therefore help them getting more motivated and improve their situation.

    Antidepressants are not perfect, yet they are not all bad. They help some people, but not everyone. Reducing a medication to only its adverse effects is an oversimplification.

  • warm_bot November 19, 2016, 9:45 am

    I was using antidepressant (2 different classes, 6 months each) during a year, and felt heavily suicidal. I was obsessed by the idea of suicide, I was seeing my self jumping from my window 100 times a day, and hearing my own voice telling angrily to myself that I’d better jump as I wasn’t worth it. After one year I gave up and try to poison myself with antidepressant. After that I came to another psychiatrist. After several sessions he told me that maybe I was “mixed bipolar”.

    It’s a particular form of bipolarity that is hard to recognize because you don’t go through maniac phases. Instead you have “hypomania”, which is hyperactivity of brain. Also depression phase happen in the same time as hypomania, hence it end up in a really messy situation. The fact is, antidepressant are super-duper not allowed for this kind of mental illness as the chances of committing a suicide are 18 times more than usual (bipolar have already great chances to feel suicidal comparing to regular population).

    Antidepressant increase hypomania, thus the hyperactivity of brain mix up with negative emotion. That’s probably why I had obsessional ideas of killing my self like seeing my self jumping from the window again and again (that’s just an example, I had many ideas every time I was somewhere). Now I take a completely different type of medication, and even if it doesn’t solve everything, I feel a great difference.

    The thing is: it’s ok for doctors to try antidepressant, when they see people who are severely depressed. But it’s not ok not to listen to them when patient say antidepressant doesn’t work at all. The doctor who prescribed me antidepressant for a year stopped believe me after 6 months being suicidal with Valdoxan. She started to tell me things like “but if you are that suicidal, why didn’t you already commit a suicide? It’s actually easy to do it (!!!)”.

    She thought I was a liar, or some pathological type of person who fake being ill to get attention. She treated me like a child, called me narcissistic, and told me that I was waiting too much from other people that they solve my own personal problems instead of doing it by myself. This didn’t help me at all, and considering my situation, I thought it was true (I was already thinking that somehow since I was depressed, unemployed, lonely, etc).

    And I wouldn’t have suspected the antidepressant to poison me instead of helping me since 1) I am not a doctor, 2) I believe what doctors say as they are supposed to have more knowledge than us, 3) as a depressed person, I was already feeling that I was a failure, and that I was responsible for all the problems in my life. Thus when the doctor told me many times that I was the problem, it was just a confirmation. The problem is really that doctors don’t listen to patient enough.

    I can forgive the doctor for prescribing me the first antidepressant, but I can’t forgive her treating me like a mess when the treatment didn’t work, as if I was responsible for that. I also cannot forgive her to almost humiliate me when I told her I was fighting not to kill myself. Sorry for writing that much but I thought it could be useful for some people. Trust yourself!

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