Drug Therapies and the Risk of Suicidality

Megan Maroney, PharmD, BCPP, clinical associate professor, Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey; clinical psychiatric pharmacist, Monmouth Medical Center, Long Branch, NJ, discusses suicidal ideation and behavior, and depression, as potential adverse effects of some medications.

Megan Maroney, PharmD, BCPP: We know that there are several classes of medications that have been associated with the risk of increases in depression and suicidality. We’re not really sure, in most cases, why that is.

There are some theories, such as with the antidepressants, we think that maybe some patients just have a different response, perhaps it increases their energy but maybe doesn’t relieve their depression right away and that may lead to increase in suicidal thinking. In other theories, that maybe perhaps patients who are undiagnosed as having bipolar disorder may start to exhibit some impulsivity and other changes in thought patterns when treated with an antidepressant.

Another example is the angiotensin receptor blockers [ARBs]. There was some literature just published recently that perhaps ARBs may have a little bit more risk of suicidality than ACE inhibitors. The theory behind that is that perhaps an increase in angiotensin type-2 in the CNS may contribute to that, may affect the neurotransmitters that affect our mood.

So, those are some of the theories that are out there, but in most cases, we really don’t know where the risk is coming from.