Drug-induced suicidal behavior, or suicidality, presents in varying degrees, from suicidal thoughts and ideation to attempted suicide and death. It is often associated with severe depression, and many patients have a history of psychiatric disorders. Medications that may cause suicidal behavior include antidepressants, antipsychotics, anticonvulsants, corticosteroids, and retinoids.

Drug-induced suicidal behavior can represent a noticeable change in thoughts and behaviors from a patient's baseline characteristics. Clinical features include agitation, irritability, impulsivity, restlessness, and ego-dystonic thoughts. With most causal medications, the onset of depression typically occurs within the first few weeks of treatment.

Antidepressants: While drug-induced suicidal behavior seems to be a rare reaction in adults, occurring in 0.04% of adults taking antidepressants, the US Food and Drug Administration (FDA) found an increased risk of suicidal behavior among children and adolescents taking any of 9 specific antidepressants (including selective serotonin reuptake inhibitors [SSRIs]) in placebo-controlled trials. This 2% increased risk was identified in children and adolescents with major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and anxiety disorders. By late 2004, the FDA required a boxed warning notifying health care providers of an increased risk of suicidality in children and adolescents treated with all antidepressants. The warning was then expanded to adults younger than age 25 years. Evidence for and against an association is mixed due to limitations in study design. Diagnosis rates for pediatric depression and treatment rates with SSRIs have trended down since the FDA advisory, causing concern for an increase in untreated depression as well as its subsequent morbidity and mortality. Providers should weigh the risk of antidepressant-induced suicidal behavior against treatment benefits and suicide risk in untreated depression. Since alternative therapies have not been established for MDD and OCD, physicians must decide what is the safest option for their pediatric patients.

Postmarketing surveillance has revealed that suicidal ideation is associated with both montelukast (used for asthma and breathing difficulties) and varenicline (known by the brand name Chantrix; used for smoking cessation), prompting the FDA to issue stronger warning language for both.

Suicidality is a significant public health issue. An estimated 49 449 people died by suicide in the United States in 2022 – the highest number of suicides ever recorded. Suicide was the ninth leading cause of death in 2021 for people aged 10-64 years. It has been found that drugs associated with increased suicidal ideation are also associated with an increase in attempted suicides and suicide deaths.

Help for suicidal behavior is available in the United States through the 988 Suicide & Crisis Lifeline or by calling 988.