Principles of using drugs associated with emergent suicidality

Suicidal thoughts and behaviours can emerge when starting and stopping drugs (both psychotropic and nonpsychotropic drugs). Consider the harms and benefits of using a drug associated with emergent suicidality. Additional caution is needed in a patient considered to be at risk of suicide (see Assessing suicide risk).

When using a drug associated with emergent suicidality, inform the patient of the risk of developing suicidal thoughts. If the patient is at risk of suicide, consider using an alternative drug if possible. If starting a drug associated with emergent suicidality (eg antidepressant therapy), develop an action plan to follow, should suicidal thoughts occur. As a precaution, schedule regular reviews with the patient (and their family, carers or significant others if applicable)—review during the first 7 to 10 days, at least weekly during the first month of treatment, and at least fortnightly during the second month. Additionally, review frequently when changing the dose or stopping drug therapy.