Does Duloxetine cause suicidal thoughts? (5+ precautions)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, We will discuss whether duloxetine can cause suicidal thoughts. Along with the factors influencing suicidal thoughts and alternative drugs which can be taken instead of duloxetine. We will also share some case reports on duloxetine-induced suicidal thoughts.
Does duloxetine cause suicidal thoughts?
Yes, duloxetine can cause suicidal thoughts in individuals undergoing therapy. If you are taking duloxetine to treat your depression, you may experience worsening of your depressive symptoms and suicidal thoughts. (1)
Study trials have shown that antidepressants cause an increased risk of suicidal thoughts and suicidal behaviour in children and young adults suffering from depression. (1)
It is mandatory to monitor for thoughts of self-harm and unusual behavioural changes in the beginning stage of antidepressant therapy and during the dose adjustment of any antidepressants.
The effect of duloxetine varies from person to person, and not everyone experiences suicidal thoughts. If you notice any negative change in your behaviour or you are having suicidal thoughts, seek medical help immediately.
What does the research suggest?
Two case studies have reported suicidal ideation accompanied by duloxetine treatment. Case 1: A 32-year-old female with a history of major depressive disorder was admitted to the hospital for a suicidal attempt by consuming 250ml of detergent. (2)
She was being treated with duloxetine 60mg and alprazolam. After five days of duloxetine treatment, she experienced enhanced depressive mood, irritability and aggression. These symptoms were exacerbated after 2-weeks of duloxetine treatment.
Case 2: A-47-year-old female was on treatment with duloxetine 60mg and alprazolam 2mg HS for two months for her depression. She showed improvement in her symptoms except for pain in her leg, followed by which duloxetine was increased to 120mg/day. (2)
After five days of increased doses of duloxetine, her pain worsened, and she experienced irritability, which worsened with time. After 3rd week of treatment, she attempted suicide by consuming 22mg of alprazolam. Suicidal attempt in these individuals was seen after introducing duloxetine to their treatment regimen. The reasons for attempting suicide in these individuals were agitation, aggression and irritability.
Suicidal behaviour and aggression can be seen in bipolar disorders treated with a single antidepressant without any mood stabilisers or antipsychotics. (3) The occurrence of suicidal thoughts after starting with antidepressants is rare. Individuals with bipolar disorder can be at a risk of having suicidal thoughts.
What are the factors that influence suicidal thoughts?
Suicidal thoughts can be influenced by various factors, such as biological, psychological and environmental factors.
Underlying disorders: Mental health conditions such as depression, anxiety, bipolar disorder, schizophrenia, ADHD and PTSD, if left untreated, can contribute to suicidal thoughts.
Family history: Mental illness is sometimes linked with genetics. Having a family history of mental illness/disorders will put you at risk of getting these disorders, which will eventually lead to a worsening of symptoms and suicidal thoughts if left untreated.
Biological factors: A sudden fluctuation in neurotransmitters such as serotonin, norepinephrine and dopamine can lead to feelings of worthlessness, agitation, irritability and aggression, which can exaggerate and cause suicidal behaviour.
Trauma: Any trauma, abuse or situations that lead to post-traumatic stress disorder can contribute to suicidal thoughts.
Chronic illness: Individuals with a chronic disease like cancer or chronic pain, where the person has a low quality of life, tend to have depressed mood, which can lead to suicidal thoughts.
Substance abuse: Addition to a substance such as stimulants, opioids, etc., can cause impulsive behaviour and suicidal ideation.
What are the alternative drug therapies to duloxetine?
If you are taking duloxetine to treat depression or anxiety and experience suicidal thoughts, you can shift to other antidepressants which have a lower risk of suicidal behaviour. Drugs such as nefazodone, mirtazapine, bupropion and venlafaxine were shown to have a lower incidence of suicide rate. (4)
Other classes of drugs, such as SSRIs (citalopram, sertraline), SNRIs (Milnacipran, venlafaxine), tricyclic antidepressants (amitriptyline, desipramine) and atypical antidepressants (bupropion, trazodone) can be used to treat depression, anxiety and pain if you are not compatible with duloxetine.
Discontinuing duloxetine and switching to other antidepressants should be done under a physician’s guidance. Discontinuing any antidepressants is done by tapering the dose to a low level before stopping the medication to avoid withdrawal symptoms. Do not discontinue duloxetine without your ,physician’s guidance as it may enhance suicidal behaviour.
What to do if duloxetine causes suicidal thoughts?
The first priority if you are experiencing suicidal thoughts is to seek medical help. If you are having suicidal thoughts after starting with duloxetine or after an increase in the dose of duloxetine, it can be treated by reducing the dose or switching to other antidepressants under a physician’s guidance.
You may experience suicidal thoughts because of any underlying condition, such as bipolar disorder. Get a proper evaluation to rule out any underlying conditions which can worsen your suicidal behaviour.
Limit your access to substances and things that could cause you harm. Work with your mental health professional to create a safety plan. Consider cognitive behavioural therapy, which will help you deal with your negative emotions. Do not hesitate to ask for help.
Conclusion:
In my perspective, duloxetine-induced suicidal thoughts are rare but some individuals can experience them. Underlying condition such as bipolar disorder increases the risk of having suicidal thoughts while on duloxetine therapy.
Ensure that you seek medical attention if your symptoms are worsening, and you notice suicidal behaviour. Do not stop the medication abruptly, as it can worsen your suicidal thoughts.
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References
1.-
Cymbalta [package insert]. Indianapolis, USA. Eli Lilly and Company. 2004. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022516lbl.pdf
2.-
Salem BA, Karam EG. Duloxetine and suicide attempts: a possible relation. Clinical Practice and Epidemiology in Mental Health. 2008 Dec;4:1-2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453113/
3.-
Rihmer Z. Suicide risk in mood disorders. Current opinion in psychiatry. 2007 Jan 1;20(1):17-22. Available from: https://pubmed.ncbi.nlm.nih.gov/17143077/
4.-
Pompili M, Serafini G, Innamorati M, Ambrosi E, Giordano G, Girardi P, Tatarelli R, Lester D. Antidepressants and suicide risk: a comprehensive overview. Pharmaceuticals. 2010 Aug 30;3(9):2861-83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034101/#:~:text=Suicide%20rates%20taken%20from%20large,100%2C000%20per%20year%20%5B4%5D.
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