I see suicidal thoughts listed as a rare medicinal side effect. How can such a specific thing be a side effect? Can other specific thoughts be a side effect?
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My understanding is that it’s not that the drug can specifically cause suicidal thoughts. Rather, the drug can significantly alter your state of mind, and suicidal thoughts is a common symptom of that, so if you have suicidal thoughts, you need to tell your doctor because it means that the drug is affecting your mind.
There’s 2 reasons mainly… the first is you’re impacting chemicals related to depression, this side effect is very common in anti-depressants, so there’s a possibility messing with that at all will increase it.
Secondly though, and I’ve found this myself, in the early days of anti-depressants…you’re possibly already suicidal to begin with which is why you’re going on it…. and before it ever actually impacts your mood, you’ll find you have an increase in energy.
So there’s a paradoxical period where you’re still very depressed, but suddenly have more energy and focus to carry out anything. So you’re at a higher risk of acting on something you already thought
I personally experienced this when I was younger, after starting a new brand of birth control pills. It caused severe mood swings and also increased my impulsivity. I wasn’t depressed or suicidal before, but the pill made me feel sudden extreme sadness and also high motivation to act on it. Fortunately, I had access to the crisis hotline. I was distracted long enough for the feelings to pass. If I had immediate access to a gun at that time, I might’ve acted without thinking. There really was no thought or desire to end my life, just feeling so overwhelmed by sadness and pain for no reason and would do anything to make it stop.
There’s this naive belief that bc is like taking a Tylenol that magically blocks pregnancy. In reality, they’re pills that disrupt women’s normal hormonal balance so their bodies won’t produce conditions conducive to conceiving. Hormones are responsible for many functions we conflate with thoughts, like hunger, satiety, sleepiness, wakefulness, fear, anxiety, sadness, joy, motivation, sexual arousal, love, excitement, focus, etc. They even influence how your body copes with pain and stress.
So a pill that changes one’s hormonal chemistry can result in a combination that results in suicidal ideation. It could be that it triggers motivation in someone who was already in emotional pain but too lethargic before to act on it. In someone else, it might trigger sadness in someone who is already impulsive. In my case, it triggered severe sadness, intense focus (which became fixation on negative thoughts), and high motivation (actively seeking out ways to stop the pain). When I switched to a brand with different combination of hormones that work better with my body’s chemistry, I returned to normal.
The ELI5 answer is, we don’t always know, and it doesn’t really matter. All we know is X people took a drug, Y percent of them developed suicidal thoughts they didn’t have before, so it’s listed as a possible side effect.
Whether they developed it directly because of the drug, or indirectly via some other neurochemical effect of the drug (perhaps the drugs allowed you to focus more on existing suicidal thoughts), or such thoughts developed purely coincidentally, makes no difference.
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