A hard-to-shake depression, hopelessness, withdrawing from family and relations are among the hints that suicidal thoughts may be affecting someone.

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On the often-lengthy list of potential side effects caused by some medications, one of the more disturbing is “suicidal thoughts.” Ironically, antidepressant medications are among the more commonly prescribed drugs that carry the suicidal thoughts warning. Antidepressants can have this effect on teens and adults within the first few months of treatment, according to warnings issued by the U.S. Food and Drug Administration (FDA).

The FDA has also received complaints about, and issued similar warnings for, a range of medications, including epilepsy drugs, the smoking cessation medication varenicline (Chantix), the influenza drug oseltamivir (Tamiflu), acne medication isotretinoin (Accutane), and montelukast (Singulair), an anti-inflammatory medication used to treat allergies and prevent asthma attacks.

Prescription sleep aids also may lead to suicidal thoughts in some people, says W. Vaughn McCall, MD, chair of the Department of Psychiatry and Health Behavior and Case Distinguished Chair at the Medical College of Georgia at Augusta University. “These medications can have a rare paradoxical effect, like alcohol, where people start behaving completely out of character,” says Dr. McCall. “Instead of calming, they may hyperstimulate; instead of being relaxed, patients become fearful; so it goes the opposite way. We don’t know why, and we can’t pick these people out in advance.”

If you or someone you know has been prescribed a medication that includes suicidal thoughts among its potential side effects, talk with your doctor about alternative treatments and warning signs that you are not tolerating the drug well.

What Triggers These Thoughts?

The association between certain medications and suicidal thoughts remains something of a mystery. Do the medications themselves cause suicidal thoughts—or do they boost thoughts or ideas that are already present?

“We know that whether or not these drugs actually cause suicidal thought or action is a question we have to answer, but up until now, none of the clinical trials for the drugs were set up to address the question,” says Kelly Posner, PhD, principal investigator at the Center for Suicide Risk Assessment at Columbia University. “Either way we have to get the right answers. It’s critical to know about drugs that pose risk, but debunking false notions of risk is equally important to the public health.’’

It’s important to keep in mind that suicidal thoughts and actual suicides that can be linked to antidepressants or other medications are not the norm. “Although antidepressants are much more likely to alleviate suicidal thoughts associated with depression than to cause them, a small proportion of individuals taking them—usually young adults, adolescents and children—may develop agitation or suicidal thinking,” says Mark Pollack, MD, with Rush University Medical Center in Chicago.

When There Is Talk of Suicide

If someone you know talks about suicide, even in a fleeting or casual manner, you should take note. This is true for people of any age.

Researchers from the University of Texas analyzed of data from the National Violent Death Reporting System, and found that the older a suicide victim was, the more likely it was that he or she shared suicidal thoughts with others.

“Findings that depressed mood, health problems and other stressors were associated with increased odds of disclosure indicate that suicide may have been prevented by providing the services needed to alleviate these problems,” explained Namkee Choi, PhD, lead researcher and professor at the university’s Steve Hicks School of Social Work. “Health care providers need better preparation to screen and aid those in need to prevent suicide.”

Friends and relatives of people on antidepressants and other medications associated with suicidal thoughts should also be prepared if conversations or behavior raise any red flags.

Signs of potentially suicidal behavior include:

• Talk of suicide, even in a joking manner.
• Sharing feelings of sadness, hopelessness, and self-criticism.
• Talking or acting in a more violent manner.
• A depressed mood.
• Withdrawing from friends, family members and routine activities.
• Significant changes in sleeping and eating patterns, as well as out-of-character behaviors, such alcohol or drug abuse, or reckless driving.

Western Michigan University reports that an estimated 50 to 75 percent of people who commit or attempt suicide give some type of warning of their plans to friends, co-workers, or family members. That’s why paying attention to critical signs and trusting your instinct can truly make the difference between life and death.

How to Respond

While it’s tempting to try to talk someone out of committing suicide with heartfelt sentiments, such as “you have so much to live for” or “your family will be so devastated.” Instead, make it clear how much you and others care about the person and they he or she is not alone. Suicidal and hopeless feelings are common, but they are also temporary and treatable. Don’t talk about suicide in terms of “right or wrong” or “good or bad.”

Someone who is feeling suicidal doesn’t want a lecture on the value of life. They want support and love. But you should also be direct.

• Talk openly with your friend or family member if he or she discusses suicide. Ask if there is a plan or the means to carry it out.
• If it appears that a suicide attempt is real and imminent possibility, do not leave the person alone for even a short time.
• If possible, remove any weapons, pills or other implements that could be used to take a life.
• Reach out to a local crisis center or hospital for guidance. You may need to take the person to a hospital or other facility yourself.

You should also be ready to actively help your friend or loved one find a therapist or treatment program, and be there as a support throughout the process.