Does Pristiq cause suicidal thoughts? (3+ studies)

In this article, we will answer the question “Does Pristiq cause suicidal thoughts?”. We will discuss what research has to say in this matter, some risk factors for suicidal ideation while taking Pristiq and some tips to help manage such symptoms.

Does Pristiq cause suicidal thoughts?

Yes, Pristiq tends to cause suicidal thoughts in some individuals taking therapy. As each individual is different, not everyone taking Pristiq experiences suicidal thoughts or ideations. 

Pristiq (Desvenlafaxine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) approved for the use of major depressive disorder (MDD) by the FDA. Some clinicians also use it for the treatment of hot flashes in women undergoing menopause.

The FDA has issued a warning for the occurrence of suicidal thoughts and behaviours in individuals on Pristiq therapy. It is advised to closely monitor patients for the emergence of suicidal thoughts and clinical worsening of the condition. The FDA has issued black box warnings of other medications like Sertraline and Duloxetine too.

Suicidal ideation with the use of SNRIs, and antidepressants in general, is more common in children and young adults taking antidepressant therapy. The mechanism behind such a phenomenon is not yet fully understood.

In addition to suicidal thoughts, Pristiq can also cause:

• Nausea
• Dizziness
• Insomnia
• Constipation
• Nightmares
• Weight gain
• Decreased appetite
• Anxiety
• Hypertension
• Somnolence
• Tachycardia
• Sweating
• Memory problems

What are the possible mechanisms of Pristiq-induced suicidality?

Some possible mechanisms leading to suicidal ideations have been proposed. One phenomenon can be of ineffectiveness of the medication being used for treatment. If Pristiq is ineffective and the depression of the patient does not resolve with the use of this medication, the depressive symptoms can exacerbate and lead to suicidal thoughts or self-harm (2).

Another mechanism was that due to the energy burst that some antidepressants give to their users, the patients may be excessively energized and start to act on their impulses. This is because medications used to treat depression cannot immediately cause an improvement in depressed mood, but can give a suicidal patient enough energy to act on his impulse. The mania experienced by individuals can sometimes also lead them to suicidal ideations (2).

One mechanism proposed that insomnia caused by antidepressants like Pristiq can increase the tendency for suicide. When comparing patients experiencing insomnia to patients who did not experience this side effect it was reported that patients with sleep disturbances had more frequent cases of suicidal ideation (2).

The authenticity of these mechanisms has yet to be fully proven, but they are a possible way through which Pristiq can influence suicidal thoughts and behaviours. Due to this reason, it has been advised by the FDA to closely monitor any such symptoms when prescribing Pristiq.

What does research suggest?

Research suggests that the use of desvenlafaxine can cause suicidal ideation in individuals taking Pristiq therapy. However, this may not be the case for all patients on Pristiq.

A research study assessing the safety and efficacy of venlafaxine and desvenlafaxine in MDD reported that patients on desvenlafaxine therapy rather than venlafaxine, experienced more frequent suicidal thoughts. From the total sample, 0.9% of desvenlafaxine reported suicidal ideation (3).

Another clinical study, reported suicidal ideation and related adverse events to be more prominent in individuals receiving desvenlafaxine therapy. This study reported that suicide attempts were rare but the risk still cannot be ruled out (4).

Another study also reported the increased frequency of suicidal thoughts of individuals on desvenlafaxine when compared to a placebo. This study stated more adverse events related to self-harm in individuals on the medication (5).

In another study evaluating the safety, efficacy and tolerability of desvenlafaxine over a time duration of 8 weeks, it was reported that patients on therapy noticed suicidal ideation as early as on the 12th day of treatment. Some individuals also noticed suicidal thoughts after 25 days of therapy (6).

What are the risk factors for suicidal ideation with Pristiq?

A few risk factors that may increase suicidal ideation in patients on Pristiq therapy are as follows:

Drug interactions

Drug interactions can be a risk factor for suicidal ideation in patients while on Pristiq. Medications that alter the brain neurotransmitters, like other SNRIs, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) can cause suicidal ideations on their own. If used in conjunction with Pristiq, this side effect is bound to increase.

Preexisting suicidal tendencies

Sometimes if the individual receiving treatment for depression has suicidal tendencies before starting Pristiq, then this may generate more such thoughts and behaviours and even cause the individual to attempt suicide.

High doses

Patients receiving high doses of Pristiq are more prone to clinical worsening or an increase in suicidal behaviour. Sometimes decreasing the dose to a more tolerable level for the individual’s body can help alleviate this side effect.

Age

Young age can be a risk factor for suicidal ideation while on Pristiq therapy. Adolescents and young adults have an increased risk of suicidal thoughts and behaviours as compared to adults. This can be due to the reason that young brains need more balanced neurotransmitters to function and because of depressive illnesses and antidepressant therapy, their normal neurotransmitter balance is not regained as easily.

Tips to help with suicidal ideation while on Pristiq

A few tips to help you with your condition while on Pristiq are as follows:

Communicate with your healthcare provider

The first and foremost thing that you should do if you are having suicidal thoughts or ideas is to communicate this to your healthcare provider. You must tell your doctor everything that you are experiencing so that he may assess the situation and come up with a plan. Your doctor will schedule follow-ups to monitor your symptoms. Make sure not to miss any follow-up appointments.

Do not make amends to your doses without consulting your doctor. Although Pristiq is not a controlled substance, it does require a prescription. So making changes to your medication, and cutting or breaking it may result in more dangerous side effects.

Educate yourself

Keeping yourself educated about your illness, and the side effects of its therapy can be beneficial for any such situation. You should make an effort to educate yourself about what negative emotions can lead to suicidal ideation and how to control them.

Join support groups

Your doctor may refer you to support groups that provide psychotherapy and help you in overcoming negative or depressive thoughts. Support groups teach you to shift your energy towards the more positive outcomes of therapy.

Ask for help

If you feel that you are not able to control your thoughts and can inflict self-harm, you must ask for help. You should tell a family member or a close friend what you are going through and ask for their help in keeping you from harming yourself.

Practice meditation

Meditation, yoga and relaxation techniques like deep breathing, can do wonders for your mental health. These techniques can reduce your stress and give you a much calmer mood. Improvement in mood can impact how you view life and decrease any suicidal ideation that you might have.

Keep in mind that these techniques do not guarantee to completely resolve your symptoms but they can be helpful. If nothing seems to work consult your doctor and ask for a better management option.

In this article, we discussed Pristiq’s effects on suicidal thoughts, what mechanisms are responsible and what research has to say in this regard. We also discussed risk factors that can increase suicidal ideation while on Pristiq and some tips on how to manage such thoughts.

To the best of my knowledge and research, Pristiq can cause suicidal ideas and behaviours in patients taking therapy, but these are manageable through close monitoring, psychotherapy and some relaxation techniques.

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