Why do so many "medications" seem to cause suicidal thoughts?

Factual Questions
41

When I was 11, I took an antibiotic I’d never taken before for strep. I had bizarre dreams and waking paranoia, and generally a bizarre several days, which the doctor thought was a reaction to the medicine, took me off it, and the bizarre stuff stopped. This was 1979.

Years later, another doctor was going through the number of antibiotics I’m allergic to, and it’s a long list. The reactions are mainly “Itchy rash,” or “swelling in the face.” But for one I said “Bizarre dreams and paranoia.” So he asked me if the drug had been prescribed for strep when I was a child. I said it was, and wondered how he knew that. He said there’s no way to know now, but it’s possible what I actually had was PANDAS-- Pediatric Autoimmune Neurological Disorder Associated with Strep. Kids who have it can have symptoms ranging from hallucinations and bizarre dreams, to episodic hyperactivity (that resolves, which is why it isn’t ADHD), to really severe OCD, and even language regression, all from an autoimmune reaction trigger by the strep.

Anecdote, not data, but just an example of how things that are not a side effect of a medication (or even a rare reaction to it) get attributed to it.

Another example: there were once thousands of people who carried the diagnosis of “vaccine injured,” and the medical establishment believed that they were vaccine-injured. The Pertussis vaccine was even changed to an acellular type to try to avoid this reaction. Turned out that when a genetic test for Dravet’s Syndrome became available, something like 97% of people with this vaccine-injury diagnosis (including someone I worked with) had this genetic condition that causes a defective sodium channel, and therefore a defect in neurotransmitters in their brains. These people are very disabled, and anyone who knew someone with this condition was understandably wary of vaccines until we began learning more about genes in the 21st century.

So, a lot of things that are listed as side effects of drugs are really just post hoc errors. But it’s an FDA rule that anything that happens after a person in a trial takes a drug gets recorded. This is why sometimes both diarrhea and constipation, or weight gain and weight loss are listed as side effects. It’s not some puzzle, or difference in different people’s metabolisms. It’s a simple post hoc error.

So, the answer, in at least some cases to “Why a medication causes suicidal thoughts” is “post hoc error.”

42

Your doctor was right, though. That doesn’t make him a horrible doctor, it makes him a responsible one. One of the potential side effects of lamictal is Stevens-Johnson syndrome, a rare and potentially fatal rash. When my doctor first put me on it, he had to monitor me to make sure I didn’t develope this side effect. Should I have refused to take my meds because of the possibility?

Anti-convulsants aren’t a picnic, and compared to anti-depressants, I know which ones I prefer. Since I’ve started taking anti-convulsants, I’m fatigued all the time, forgetful, my nails are brittle, and my hair is thinning.

There are always risks with any medical treatment, not just medication. No doctor can say, “I 100% guarantee you.” They’re doctors, not miracle workers.

43

I have a cousin who takes anticonvulsants. She has not had a seizure since childhood, so as long as she’s on the meds, she can drive. She was a very heavy teen; when she got on some of the newer meds in the 1990s, she slimmed down to about 150lbs., but she will never be really thin. However, she could not do the job she loves, being a social worker, if she couldn’t drive.

She went off the meds once as an adult, and didn’t have a seizure, but she felt, she said “shaky,” and just odd, and frequently the way some people who get auras several hours before a seizure describe. So she went back on the meds.

44

I sort of remember when first starting Lamictal and (no doubt) in a particularly black frame of mind, of wondering which would come first, Stevens Johnson or suicide–either event looked forward kind of hopeful and wistful (I guess you had to be there :)), but then deciding I’d rather kill myself than die of living-skindeath.

Which actually was a healthy thought, given the circumstances.

45

Doing something, doing nothing, doing something different … different best (or at least least poor) answers for different people at different times, no question.

But dang … hormonal based contraceptions (oral, implantable, or IUD) are drugs and hormones have been abused by many. They have potential serious risks and potential consequences - venous thromboembolism, strokes, risks of both much higher, some cancer risks higher some lower. These are things that can kill people and have. Unwanted pregnancy of course also has risks and consequences. Women sometimes die as a result of pregnancy too. Should a woman automatically decide against using a hormonal contraception method because a provider cannot state that those rare events will definitively absolutely not happen?

Or should an individual woman, with information discussed with a trusted provider, consider the risks and benefits and how they apply to her at that particular point in her life, and make a choice based not on DRUGS=BAD but on the specifics of the possible options in comparison with each other?

46

You know, it seems to me that stating that EVERY SINGLE DRUG, EVER = BAD, just because a few have the potential for abuse is a little like saying that EVERY SINGLE LIQUID EVER = BAD just because alcohol has the potential for abuse.

47

ANY medication can have bad side effects. For years I was able to take penicillin. Then I developed an allergic reaction. Again, doctors aren’t fortune tellers.

48

Crazymeds is actually a long running well moderated and useful site. It’s full of direct first hand reports of almost every type of psychiatric drug you can think of. The name is self deprecating humor.
As the website says: “At Crazymeds we make psychiatric and neurological conditions (AKA brain cooties) our bitches with evidence-based medicine and a healthy dose of gallows humor”

It really a very useful resource, since they talk about side effects in a practical day to day life way, rather than the clinical descriptions.

49

recuperating when ill or injured means resting, like hibernation.

depression might be a remnant of the ability to hibernate… seems similar to me … wanting to sleep, having to fight the feeling to get outside. feeling sore like you must have been run over by a truck… Just like we might be naturally sleepy all winter if we were trapped inside by the winter weather… we sleep a lot.

Thats why either weather or injury can trigger it ?

50

Want to kill a day or 5?

Think of a drug - even OTC stuff predating aspirin.

There are now thousands of reference sites for drugs.

“side effects and contra-indications”.

Short form - if you are a woman of childbearing age, don’t even think about it.
(we now have a new class of grading - 'pregnancy complications". Fav: “Can’t be ruled out”. Thanks! that is a great help!
(OK, not fair - there is a new line to fill out, and nothing to put on the line)

and - before using an anti-depressant, find out how they all work. i quit once i saw that jumble of neuro-chemical interaction

51

Because the antidepressant effects start working. One idea is that the lower serotonin causes the brain to upgregulate serotonin receptors to compensate. Hence why drugs that do directly reduce serotonin have antidepressant effects, just like SSRIs.

Others suggest that other neurotransmitters change to compensate for the difference, either in actual amounts or in receptivity. This is largely stated for why SSRIs eventually have anti-anxiety effects similar to drugs that affect GABA.

One of the ideas for the holy grail–fast acting antidepressants–is finding a way to cause a response more directly. Though, currently, they are looking at dissociatives, like ketamine. And some suggest that MDMA should be studied for this effect.

52

Wellbutrin (generic-- buproprion) supposedly works pretty fast. Not everyone can take it, but it has an advantage over the SSRIs in not suppressing libido. I know one person who claimed to feel better after taking her first pill of Wellbutrin, and she was pretty damn depressed-- she was hospitalized after a suicide attempt, which is where she was given the Wellbutrin. She didn’t sleep all night the first day she took it, but felt completely fine the next morning-- she just watched TV and read a book all night. She said she felt like she could conquer the world. Then after a good night’s sleep the second night, and a second dose, she felt normal, but not depressed, for the first time in years.

That’s anecdote, not data, but I also know two people who took bupropion as Zyban, an anti-smoking drug, and it worked right away. They couldn’t taste the cigarettes anymore.

My point is, at least some people experience immediate effects from antidepressants, and Wellbutrin seems to lead the pack here, but there are a lot of contraindications-- one is seizures, and another is heart problems. Also, I think people on certain kinds of birth control aren’t supposed to take it.

All IIRC, and IANAD.

53

I felt the effects of wellbutrin within a matter of hours, that was the beginning of one of the best years of my life.

54

I didn’t want to go into it at first, because I’ve never been on meds for depression, but I’ve been on anti-depressants for an off-label reason. I was put on Wellbutrin not for depression, but as part of an insomnia regimen. It had me bouncing of the walls, and I was taking the kind that isn’t sustained-released, and only 50mg-- I had to break 100mg in half.

I was bouncing off the walls. The doctor swore I’d get used to it, but after three days, it wasn’t doing what it was supposed to do, so they tried Ritalin, and then dextroamphetamine. The dextro worked the best, and I ended up taking just the smallest imaginable dose of it. I get only 7 pills a month, and break them in quarters, because they don’t make a small enough dose for me.

Believe it or not, it’s part of a treatment for insomnia. I take the dextro first thing in the morning, so I get out of bed, even if I had a bad night, and I’m active during the day, so I burn up enough energy to be ready to sleep-- that’s really just a side-effect, though. I have more REM sleep on it, and that makes me have more productive sleep. I also take an anti-convulsant, which I think I mentioned earlier, and some melatonin. As long as I stick to a strict go to bed-wake up schedule, and don’t drink caffeine after 2pm, the dextro, anti-convulsant, and melatonin have me sleeping really well. But I also have two PRNs just in case-- Ambien and a lesser-used bezodiazepine called clonazepam.

I was also once on a tricyclic antidepressant, which made me sleep really well, but also left me a little hung over, and I felt that the first night as well.

It really depends on a lot of things. How large is the initial dose? sometimes it isn’t therapeutic, because the doctor is watching for reactions; how fast do you respond-- obviously, I’m a fast responder, but some people take more time; and what is the drug trying to achieve. Drugs trying to life depression have more work to do than drugs that just need to put you into REM sleep.