Antidepressants and risk of suicide

Most antidepressants are generally safe, but the Food and Drug Administration requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Making antidepressants work for you

There are several steps you can take to get the best results:

  • Be patient. Once you and your doctor have selected an antidepressant, it may take six or more weeks for it to be fully effective. With some medications, you can take the full dosage immediately. With others, you may need to gradually increase your dose. Talk to your doctor or therapist about coping with depression symptoms as you wait for medications to take effect.
  • See if the side effects improve. Many antidepressants cause side effects that improve with time. For example, initial side effects when starting an SSRI can include dry mouth, nausea, loose bowel movements, headache and insomnia, but these symptoms usually go away as your body adjusts to the antidepressant.
  • If it doesn't work, try something else. If you have bothersome side effects or no significant improvement in your symptoms after six weeks, talk to your doctor about changing the dose, trying a different antidepressant (switching), or adding a second antidepressant or another medication (augmentation). A medication combination may work better for you than a single antidepressant.
  • Take your antidepressant consistently and at the correct dose. If your medication doesn't seem to be working or is causing bothersome side effects, call your doctor before making any changes.
  • Don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause significant withdrawal-like symptoms unless you slowly taper off your dose. Quitting suddenly may cause a sudden worsening of depression.
  • Try psychotherapy. In many cases, combining an antidepressant with mental health counseling (psychotherapy) is more effective than taking an antidepressant alone. It can also help prevent your depression from returning once you're feeling better.
  • Avoid alcohol and illegal drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance abuse.
Nov. 25, 2014 See more In-depth