A Closer Look At A Dangerous Side Effect of Antidepressants
By: Kelley Jhung
Tags: Depression, Antidepressants, Mental Health, Suicide, Akathisia

Content Warning: This article contains detailed descriptions of suicidal ideation. More, the information here is does not oppose antidepressants. Antidepressants have helped many people, including myself. Also, I am not a doctor nor am I a mental health professional.

I’m in an overwater bungalow in Moorea, French Polynesia, clutching my heart, deliberating over ways to kill myself. I’ve been on a new anti-depressant — the fourth I’ve tried this year — for seven days. Despite the hope I’d had that it would help take me out of my misery or at least keep me from wanting to take my own life, it has made me feel even worse than before I started it.

I’m in one of the most beautiful places in the world, with the man I love, but my soul is screaming. It’s being scorched alive. The only way to stop the searing fury is for me to die. I cannot sleep. The overwhelming urge to kill myself devours any part of my spirit that, during these past 10 months of depression, still had the ability to fight.

I’ve been on a new anti-depressant medication, Pristiq for seven days.

When you have done everything to fight, and you realize there are no options left but to kill yourself, the decision to give in should be a relief.

But as desperate as I am to end my suffering, I’m still afraid to do it. And yet — and this is new for me — what overrides my fear is a pervasive and impersonal force that dictates that I need to kill myself. Even though I’m frightened, I am also dispassionate, which again, is not like me.

A 2010 article in CNS Neuroscience & Therapeutics, highlights that “Antidepressant-induced suicidality appears to be an uncommon occurrence but also a legitimate phenomenon.” The article goes on to discuss case-reports of antidepressant-induced suicidality, but also points out how, for the most part, the benefits of antidepressants outweigh the risks.

To most people taking antidepressants, this is not new information. All antidepressants list suicidal ideation as a side effect. A black box warning was issued in 2004 and revised in 2007, warning of the increased risk of suicidality for patients under the age of 25 who take antidepressants.

I’d been aware of this side effect every time I’d started a new antidepressant. I’m usually already suicidal before starting any of these drugs, so I feel I have nothing to lose. And some have helped me greatly.

Then, enter Pristiq. Four days before we left on our trip, I was so depressed I did not think I’d be able to travel. In a last ditch effort to save myself, I popped a 25 mg. Pristiq pill from a prescription I’d picked up a week before. And after taking just that one pill, I felt a lift in my mood.

I also experienced a more positive outlook the second day I was on it. I woke up early, running at 6:30 am and relishing the chilly air and sunshine. I enjoyed being around people at my volunteer job, driving home that day thinking, “I’m doing something meaningful.”

But during days three and four on the drug my mood bounced between tolerable and despondent multiple times. I was also plagued with insomnia.

I felt more restless than usual — akathisia, I’ve later learned. Akathisia is a side effect of some psychiatric medications. It involves inner restlessness accompanied by mental distress.

A 2002 NCBI article, “Akathisia: Overlooked At A Cost,” reports,

“It’s often difficult for patients to recognize that they’re experiencing akathisia; it’s often mistaken for anxiety or depression.”

Similarly, I thought I was anxious and depressed, but that I’d push through the discomfort when the Pristiq fully kicked in.

By the time my husband and I were on vacation in Moorea, Pristiq’s side effects were raging. He’d booked this trip to a beautiful place thinking it’d help cure my depression. Both of us had naively hoped that being in paradise with no demands placed on me, and spending time together, would at least curb the malady in my mind.

Fast forward to the overwater bungalow and my impulse to die by suicide at 2 am.

I have never had such strong, unemotional suicidal ideation.

Let me explain: my usual suicidal ideation involved crying, emotional pain, and hopelessness. This time, I did not cry. Agitation bubbled up from under the skin of a flat, detached person. Instead of my standard sadness and desire to end the pain, I felt like I was required to die.

I now believe medication-induced akathisia caused this more depersonalized yet urgent suicidality.

Similarly, a 2017 New York Times article, “Lawsuit Over a Suicide Points to a Risk of Antidepressants”, discusses how one woman successfully sued Glaxo, the makers of the antidepressant Paxil, after her husband jumped in front of a train after starting the drug. This man also experienced akathisia, which his wife reported played a key role in his suicide.

I email my psychiatrist; it’s 2 am and I won’t hear back from her for at least five hours. But maybe we can have a remote session in the morning.

Then I take what’s left of my emergency travel Xanax. I fade into the laconic state between sleeping and waking. It’s not the oblivion I’d hoped for, but at the very least, it stops me from acting on my suicidal urges.

When the Xanax wears off, I consider swimming out to the rough part of the Pacific Ocean and letting the Tahitian currents take control.

I pace the room as my thoughts dart around — would a fishing boat find me first, then put me on a 72-hour hold? Maybe — it’s 5 am and the sun won’t be up for an hour, but an hour isn’t long enough to guarantee the currents or sharks can kill me before someone finds me alive. But how will I get through another day? What if Dr. P. doesn’t email me back? You need to die by suicide. You can’t live anymore.

My psychiatrist emails me back at 7 am. We’ve set a Zoom meeting for 11 am.

“You promised Dr. P. that you’d talk to her before killing yourself. At least wait a few more hours before you do it,” I tell myself.

When we do meet, I robotically tell her, “I know my affect is flat, but I feel like I’m jumping out of my skin. I have a strong urge to kill myself. ”

We come up with two possible interventions while I’m still out of the country: either I go back on a doubled dose of Prozac from what I was taking before, or I double the Pristiq. “You’re not on a therapeutic dose yet; we don’t know if it‘s fully working.”

“What about the black box warning of suicide with this drug?”

“That warning pertains more to people under the age of 25.”

“Hm. Ok.”

My gut still tells me to go back on a stronger dose of Prozac; something about my emotionless suicidality makes me fear the Pristiq, despite her assurances about the black box warning. I love Dr. P. because she lets me make decisions about my medication. She gives me options, but does not try to sway me in one direction or another.

I am very fortunate I chose to double my Prozac and discontinue the Pristiq. I am not here to villianize Pristiq or antidepressants in general. It has worked for many people who suffer from major depression. Other antidepressants, Prozac included, have also caused akathisia and suicidal thinking, often resulting in fatal outcomes.

But these medications have also profoundly helped many who suffer from mental illness.

I am here to point out that the black box warning, especially regarding akathisia, needs to be taken more seriously with both patients under and over age 25.

I took the same risk when doubling my Prozac — that, too, could have caused me akathisia and robotic suicidality. Fortunately, though, it has helped my depression greatly. I haven’t contemplated suicide in over a week. In that respect, the drug has saved my life.

But after having experienced akathisia and a different, more impersonal type of suicidal ideation on Pristiq, I’ve learned that adults and young people alike need to be more aware of this potentially deadly side effect.