Several classes of medications carry warnings about suicidal thoughts, ranging from antidepressants and anti-seizure drugs to asthma medicines and corticosteroids. The risk is generally small in absolute terms, but it’s real enough that the FDA has required its strongest label warning on multiple drug categories. Understanding which medications are involved, when the risk is highest, and what to watch for can help you stay alert without panicking.
Antidepressants
Antidepressants are the most widely discussed medications in this category, which can feel counterintuitive since they’re prescribed to treat depression. In 2004, the FDA required a boxed warning on all classes of antidepressants, including SSRIs (like fluoxetine and sertraline), SNRIs, and older types like tricyclics. The warning applies specifically to children, adolescents, and young adults up to age 25.
The numbers from the FDA’s own pooled analysis: about 4% of young people taking antidepressants in clinical trials experienced suicidal thoughts or behavior, compared to 2% on placebo. No completed suicides occurred in these trials, but the doubling of risk was enough to trigger the strongest possible label warning. For adults over 25, the data do not show the same elevated risk, and for adults over 65, antidepressants may actually reduce suicidal thinking.
The risk is highest in the first few weeks of treatment. A large study of nearly 160,000 antidepressant users found elevated risk of suicidal behavior during the first month, especially the first 9 days. One explanation is that antidepressants can restore energy and motivation before they fully lift a person’s mood, creating a window where someone who was too depressed to act on dark thoughts now has the drive to do so. Another possibility is a direct pharmacological effect in a small subset of patients, particularly a surge of restlessness and agitation that some people experience early in treatment.
Anti-Seizure Medications
In 2008, the FDA issued an alert covering the entire class of anti-seizure drugs (also called anticonvulsants or antiepileptic drugs). These medications are prescribed not only for epilepsy but also for nerve pain, bipolar disorder, and migraine prevention, so a large number of people take them. The FDA’s analysis of nearly 200 clinical trials found that patients on these drugs had roughly twice the risk of suicidal thoughts or behavior compared to those on placebo. The risk applied across different conditions and across different drugs in the class, though some individual medications had stronger signals than others.
If you take a medication for seizures, nerve pain, or mood stabilization, its label likely carries this warning. As with antidepressants, the early weeks of treatment or dose changes are the period to watch most closely.
Montelukast (Singulair)
This one surprises many people. Montelukast is an asthma and allergy medication commonly prescribed to both children and adults. In 2020, the FDA added a boxed warning after determining that many prescribers and patients were unaware of the drug’s potential for serious mood and behavior changes, including suicidal thoughts.
The reported effects go beyond low mood. They include agitation, aggression, vivid or disturbing dreams, hallucinations, anxiety, disorientation, and obsessive-compulsive symptoms. The FDA now recommends that montelukast only be used for allergic rhinitis (hay fever) when other allergy medicines haven’t worked or aren’t tolerated. For asthma, it remains an option, but prescribers are expected to weigh the mental health risks before writing the prescription. If you or your child experience mood or behavior changes while taking montelukast, stopping the medication and contacting a prescriber promptly is the recommended step.
Smoking Cessation Drugs
Varenicline, the active ingredient in the smoking cessation drug previously sold as Chantix, has carried warnings about mood changes, hostility, agitation, depressed mood, and suicidal thoughts. Two large FDA-sponsored studies comparing varenicline to nicotine replacement therapy (patches, gum) did not find a higher rate of psychiatric hospitalizations with varenicline. However, these studies only tracked events severe enough to require hospitalization and weren’t large enough to detect rare side effects, so they don’t rule out a smaller-scale risk. The FDA has maintained warnings in the drug’s labeling while concluding that the benefits of quitting smoking generally outweigh the risks.
Corticosteroids
Steroids like prednisone, prescribed for inflammation in conditions ranging from asthma flares to autoimmune diseases, are well known for causing mood swings. Short-term, high-dose courses (particularly above 40 mg of prednisone daily) are most likely to trigger mood symptoms, which can include euphoria, irritability, anxiety, and in some cases depression severe enough to include suicidal thinking. Long-term steroid therapy carries its own pattern: depressive symptoms tend to emerge more gradually and can also lead to suicidal behavior in vulnerable patients.
These mood effects are dose-dependent, meaning lower doses carry less risk. If you’re on a high-dose steroid course and notice significant mood changes, that’s worth raising with your prescriber, as adjusting the dose or switching medications is often possible.
Certain Blood Pressure Medications
Some beta-blockers, particularly those that are fat-soluble enough to cross into the brain, have been linked to depression and suicidal thinking. A study examining suicide risk across different beta-blockers found a clear pattern: users of highly fat-soluble beta-blockers had a suicide risk roughly 2.7 times higher than expected, while users of low-fat-solubility beta-blockers showed no increased risk at all. The mechanism likely involves these drugs’ ability to affect brain chemistry once they cross the blood-brain barrier. Not all beta-blockers carry this risk equally, so the specific drug matters.
Isotretinoin (Accutane)
Isotretinoin, the powerful acne medication originally sold as Accutane, has been the subject of intense concern and litigation over psychiatric side effects. Media coverage has linked it to depression and suicide for decades. However, the clinical data tell a more nuanced story. No causal link between isotretinoin and psychiatric side effects has been established, and tracking data from the iPLEDGE registry (which monitors all isotretinoin patients) found suicide rates of 5.6 to 8.4 per 100,000 patients, which is actually lower than the rate in the general U.S. population of the same age group. Severe acne itself is strongly associated with depression and social isolation, which complicates any attempt to separate the drug’s effects from the condition it treats. Still, patients and prescribers are advised to monitor mood during treatment.
GLP-1 Weight Loss and Diabetes Drugs
With the explosion in popularity of drugs like semaglutide (Ozempic, Wegovy) and similar GLP-1 receptor agonists, reports of suicidal thoughts in users prompted an FDA review. As of early 2026, the FDA’s preliminary evaluation has not found evidence that these drugs cause suicidal thoughts. Reviews of adverse event reports, clinical trials, and large observational studies did not show a clear association. That said, the agency notes it cannot definitively rule out a small risk because suicidal events were rare in both treatment and control groups. Additional analyses are ongoing.
What the Risk Window Looks Like
Across most of these medications, the highest-risk period is the first few weeks after starting or changing a dose. This is especially well documented for antidepressants, where the first 9 days stand out as the most vulnerable window. The pattern makes sense pharmacologically: your brain is adjusting to a new chemical environment, and that adjustment period can produce unexpected emotional effects before things stabilize.
The signs to watch for aren’t always as obvious as a clear thought of self-harm. New or worsening anxiety, a feeling of restlessness you can’t shake, irritability that feels out of proportion, insomnia, or a sudden emotional flatness can all be early signals. These changes are worth reporting to whoever prescribed the medication, even if they seem minor. In many cases, the solution is a dose adjustment, a switch to a different medication, or simply closer monitoring during the transition period. The existence of a warning doesn’t mean a medication is unsafe for you. It means that awareness during the early weeks of treatment is genuinely important.