Suicidal ideation and behavior as adverse events of prescribed medications: An update for pharmacists

Suicide is the tenth leading cause of death in the US, and the Food and Drug Administration (FDA) has labeled more than 125 prescription drugs for potential adverse effects of suicidal ideation and behavior. Several are in the top 200 for highest dispensed volume, including the entire class of antiepileptics. Also included are drugs used to treat urinary incontinence, an antibiotic, and smoking cessation agents. We describe the importance of pharmacists' identification and management of these complex adverse events and conclude with the potential for Department of Veterans Affairs and other big data longitudinal clinical research projects to provide additional insight into the complex causes of this adverse event.

Questions persist about causality (pharmacologic provocation of suicide) in the context of psychiatric treatment response (treatment emergence) and the multifactorial pathogenesis of suicidal behavior, which is distinct from suicidal ideation. In the future, big data with the use of medical records (rather than claims) may provide valuable insights into this question.

Pharmacists are encouraged to file adverse event reports for suicide and suicide attempts resulting in death, disability, or hospitalization via MedWatch even if the reports are incomplete. Resources to support pharmacists managing patients at risk include hotlines, chatlines, texting, and free federally funded online training.