What is the best antidepressant for suicidal thoughts? (3+ options) 

In this blog post, we are going to answer the question, “What is the best antidepressant for suicidal thoughts?”. Antidepressants are one of the most commonly prescribed medications in the entire world. This is because depression has become a widespread mental illness and it is affecting people mentally, as well as physically. 

One of the biggest concerns with depression is suicidal behaviour. This is indeed an alarming issue that hits people inevitably. This blog will talk about the best possible antidepressant for the treatment of suicidal behaviour. 

What is the best antidepressant for suicidal thoughts?

The best antidepressants for suicidal thoughts include:

• Selective serotonin reuptake inhibitors (SSRIs) 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) 
• Atypical antidepressants 
• Tricyclic antidepressants (TCAs) 

Selective serotonin reuptake inhibitors (SSRIs) 

SSRIs are one of the most commonly prescribed antidepressants for the treatment and management of mild to severe episodes of depression. These meds can significantly help elevate your mood and counteract the symptoms associated with your mental health condition. 

However, they may not suit everyone. Several studies suggest that SSRIs, although they are considered the safest antidepressants, may cause unbearable side effects in some individuals which may lead to the discontinuation of treatment with these meds.

However, SSRIs are quite effective in the treatment of depression and the suicidal thoughts that come with it. They work by inhibiting the reuptake of serotonin, which is an excitatory monoamine neurotransmitter responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

SSRIs increase serotonin by blocking serotonin transporters (SERT). The excess serotonin activity can elevate your mood, make you think positively, and may increase your energy levels. 

One of the most important safety concerns is related to the use of SSRIs in people younger than 24 years of age. When these meds were first introduced, adults seemed to tolerate them well and so did the young adults and children. 

However, one thing that was observed was the suicidal behaviour induced by SSRIs in younger population. This led to the black-box warning issued by the Food and Drug Administration (FDA) that SSRIs can induce suicidal behaviour in the younger population and they should be closely monitored. 

The parents and caregivers were warned to keep an eye on such people and to seek immediate medical attention if they show unusual behaviour. Some of the common SSRIs include:

• Sertraline (Zoloft) 
• Fluoxetine (Prozac) 
• Escitalopram (Lexapro) 
• Paroxetine (Paxil) 
• Citalopram (Celexa) 

Among the above-mentioned SSRIs, Fluoxetine is believed to be the one which can enhance your energy levels and motivation. When you feel motivated, you’ve diverted further away and away from the thoughts of suicide or any other self-harming behaviour. 

However, only your healthcare provider can determine the best possible choice of antidepressant for you. Some common side effects associated with the use of SSRIs include

• Nausea 
• Vomiting 
• Diarrhoea or Constipation 
• Acid reflux or heartburn 
• Abdominal pain 
• Loss of appetite 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Drowsiness 
• Dizziness 
• Excessive tiredness or fatigue 
• Insomnia or inability to fall asleep 
• Xerostomia or dry mouth 
• Dysmenorrhea or heavy periods
• Flu-like symptoms, including irritation in eyes and runny nose
• Sexual side effects 

Serotonin-norepinephrine reuptake inhibitors (SNRIs) 

SNRIs are also well-tolerated antidepressants and they can actively counteract the suicidal symptoms associated with depression. SNRIs work by inhibiting the reuptake of two excitatory monoamine neurotransmitters; serotonin and norepinephrine. 

They do so by blocking serotonin and norepinephrine transporters, SERT and NET respectively. This way, there is more serotonin and norepinephrine present in your synaptic cleft to bind to their respective receptors. 

These excitatory neurotransmitters help elevate your mood and counteract depressive behaviour. However, SNRIs may also induce suicidal behaviour in people who are younger than 24 years of age. Some studies suggest that this effect is not always present. 

The best way to make sure that the med does not harm you is to start the treatment from the lowest effective dose. In case of an unfortunate event or an inevitable allergic reaction, the damage caused by lower doses is easy to deal with.

People tend to recover faster from the side effects, whereas higher doses can cause far more damage and some of it may not be repaired. Some of the common SNRIs include:

• Venlafaxine (Effexor) 
• Duloxetine (Cymbalta) 
• Desvenlafaxine (Pristiq) 
• Milnacipran (Ixel) 
• Levomilnacipran (Fetzima) 

Some of the common side effects associated with the use of SNRIs include:

• Drowsiness
• Fatigue
• Sleepiness or hypersomnia
• Decreased salivation leading to dry mouth 
• Vertigo 
• Loss of appetite 
• Excessive sweating
• Constipation or diarrhoea 
• Weight gain or loss
• Abdominal pain
• Bloating 
• Flatulence 
• Headache 
• Muscular pain

Atypical antidepressants 

Atypical antidepressants can also be used for the management and treatment of major depressive disorder and related suicidal behaviour. They are so-called because of their distinct mechanism of action. Unlike other antidepressants, they do inhibit the reuptake of any excitatory neurotransmitter. 

Instead, atypical antidepressants have a dual mode of action. They can activate 5-HT1 receptors, which are one of the serotonin receptors. 

They also enhance the stimulatory action of the noradrenergic system which increases the secretion of serotonin, while preventing the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

This means that instead of inhibiting the reuptake of serotonin from the synaptic cleft, atypical antidepressants work to increase the secretion of the said excitatory neurotransmitter. 

They are also serotonin-specific and may or may not affect other neurotransmitters. The exact mechanism of action is still a topic for research. Some common atypical antidepressants include:

• Mirtazapine (Remeron) 
• Vortioxetine (Trintellix) 
• Trazodone (Desyrel) 
• Nefazodone (Serzone) 

Some of the common side effects associated with the use of atypical antidepressants include:

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects, including nausea, vomiting and diarrhoea/Constipation 

Tricyclic antidepressants (TCAs) 

TCAs were once considered the strongest antidepressants and they do not induce any kind of suicidal behaviour. However, this antidepressant is associated with the highest number of side effects. 

TCAs are quite effective in the management and treatment of depression and suicidal behaviour, but they are not tolerated by every single individual. These meds were once used as the first line of therapy for depression, but later the newer and safer antidepressants replaced them. 

These meds work by inhibiting the reuptake of serotonin and norepinephrine, but they do bind to a number of other receptors which is the main cause of the side effects. Some of the TCAs include

• Elavil (Amitriptyline) 
• Pamelor (Nortriptyline) 
• Tofranil (Imipramine) 

Some of the side effects associated with the use of TCAs include:

• Painful urination 
• Dry mouth or xerostomia
• Gastrointestinal side effects, including nausea and vomiting 
• Weight gain
• Vertigo 
• Drowsiness or extreme fatigue 
• Constipation 
• Abdominal pain
• Enlarged breasts
• Heartburn
• Excessive sweating 

What other treatment options are available for people with suicidal thoughts? 

There are other treatment options for people with suicidal behaviour, one of which include Psychotherapy. Therapy should be the first option as it can significantly help a lot of people. 

Many people refrain from visiting a therapist and they don’t usually believe this kind of therapy session to work, but there is a reason why they exist.

When you sit and talk to someone you don’t even know, someone you know is there to help you, someone you know who won’t judge you, you find a sense of comfort in that conversation. 

It can be difficult at first, to open up to a complete stranger, but as you begin to let that negative energy out of your bind, you will slowly begin to feel better. 

It is a known scientific fact that releasing the negative energy from your body and not letting it make its home inside your head can significantly help you recover from depression. If you have been feeling suicidal lately, you should definitely talk to a therapist. 

I may not know what’s bothering you, but I can tell you for sure that your life is worth every single thing on this planet. You’re just as important as every single one of us and your life matters. You should never think about self-harm. 

Conclusion 

In this blog post, we have discussed the best antidepressant to take for suicidal behaviour. We have learned that several classes of antidepressants can help you overcome your suicidal thoughts. These include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, atypical antidepressants, tricyclic antidepressants etc. 

Therapy sessions should also be considered a good addition to your treatment regimen. Make sure you take good care of yourself and always consult a mental healthcare professional if you feel lost or too depressed to carry on. 

FAQs: Best antidepressant for suicidal thoughts 

Do antidepressants induce suicidal behaviour? 

Yes, some antidepressants do induce suicidal behaviour. The Food and Drug Administration (FDA) issued a black-box warning regarding the use of SSRIs and SNRIs. The warning stated that these meds can induce suicidal behaviour in people younger than 24 and should be closely monitored. The parents and caregivers were warned to keep an eye on such people and to seek immediate medical attention if they show unusual behaviour. 

What is the number 1 prescribed antidepressant?

Zoloft is the most commonly prescribed antidepressant, almost in the entire world. It is a selective serotonin reuptake inhibitor (SSRI). It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). Zoloft is generally well tolerated and it has changed many lives, but it may cause serious side effects in some individuals. Make sure you ask your healthcare provider before using Zoloft. 

What are the stronger antidepressants?

SSRIs are the strongest and the most frequently prescribed antidepressants in the entire world. These drugs are very well tolerated and can significantly help restore your mental health. Even in the case of major depressive disorder, some doctors prescribe two SSRIs in combination, mostly Sertraline and Escitalopram, to help relieve the disturbing symptoms associated with persistent depression. SSRIs basically inhibit the reuptake of serotonin by blocking serotonin transporters (SERT).

How to treat suicidal behaviour? 

Therapy should be the first option as it can significantly help a lot of people. Many people refrain from visiting a therapist and they don’t usually believe this kind of therapy session to work, but there is a reason why they exist. It is a known scientific fact that releasing the negative energy from your body and not letting it make its home inside your head can significantly help you recover from depression. If you have been feeling suicidal lately, you should definitely talk to a therapist.

What type of antidepressant gives you energy?

The type of antidepressant that treats your depression-induced lethargy can help boost your energy levels. The most common examples include Wellbutrin and Prozac. The kind of antidepressant you should take depends on the type of symptoms you have. Suppose you suffer from depression-induced insomnia. There’s no point in taking a medication like Wellbutrin as it’ll make you even more restless. For such a person, taking an antidepressant that can help them fall asleep is a better choice. 

References 

• Depression, Risk of Suicide, and Treatment Options https://www.drugs.com/slideshow/antidepressants-managing-side-effects-1079
• Suicide and Antidepressants: What Current Evidence Indicates https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/ 
• Selective Serotonin Reuptake Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK554406/
• SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants https://pubmed.ncbi.nlm.nih.gov/16142213/
• Tricyclic antidepressants https://www.ncbi.nlm.nih.gov/books/NBK557791/