Eli5: Why do so many antidepressants have sucidal thoughts as a possible side effect?
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A therapist (not a doctor, nor am I and I never tried to verify) explained it to me like this.
Sometimes people are so depressed, they want to kill themselves be have no motivation to do it. As the antidepressants start kicking in (which can take weeks), the depression lessens. For some people, the motivation to do things in general comes back before the suicidal ideations go away.
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I once had a doctor explain to me that there isn’t a definitive answer, but one leading theory is that when depressed people are given their motivation back, they might finally go through with their plans. Another is simply that not all medications work for everyone, especially if your diagnosis isn’t certain. Also, a lot of people on antidepressants have suicidal thoughts/ideations. Even if the antidepressants aren’t a cause, it’s pretty hard to actually prove that they one 100% aren’t.
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When a drug goes through trials, people are asked to report potential side effects. If a specific side effect is reported, it must be listed as a side effect of the drug. They do not try to prove that the drug is solely responsible for the effect as that would be essentially impossible.
Now consider who uses anti-depressants. These are people who are likely at a higher risk of suicidal thoughts in general. Therefore it’s almost expected that they would have reported that side effect.
What is important to look at is the likelihood and severity of the potential side effects. This information is readily available online. Death is a common side effect of almost every drug, but often it’s very unlikely.
Anti-depressants are also NOT a one size fits all drug. They mess with your brain chemistry and sometimes the switches they are flipping just aren’t the right ones. They are also often misused as people will often stop taking them as they feel better thinking themselves cured. They are incredibly useful when used correctly and when a good mix is found. But sometimes it takes some trial and error.
One of the symptoms of depression is a lack of desire to do things—anything. Getting out of bed; making a meal; cleaning; bathing; exercising; brushing your teeth; etc.
When you start to take antidepressants—and they start to take affect after 4-6 weeks—the underlining “cause” of your depression hasn’t changed; however, you may feel more able to do things.
At the back of your mind, you have had suicidal ideations but just couldn’t be bothered to act on them. Just like you couldn’t be bothered getting out of bed.
Now, you are starting to feel a little more active, however, you still have suicidal thoughts. This is a perfect storm for such a person to try to / commit suicide.
When medications are tested on a sample size of individuals before FDA approval etc, the participants are required to list any and all ill effects they experience while on the medication, even if they are being caused by something completely different.
This is why most medications have completely wacky side effects listed that have nothing to do with their actual mechanism of action. Depression as a side effect could very well just be “well, I’m still feeling as bad as I did before the medication, so nothing has changed.”
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