Antidepressant Use Associated With More Violent Suicide Attempts

A new study found that taking an antidepressant medication was associated with a heightened risk of suicide using violent means.


A new study found that taking an antidepressant medication was associated with a heightened risk of suicide using violent means. The research was led by Jonas Forsman, in the Department of Clinical Neuroscience in Sweden’s Karolinska Institutet. It was published in the European Journal of Clinical Pharmacology.

According to the researchers, “SSRIs treatment not exceeding 28 days conferred an almost fourfold risk of violent suicide.” This indicates that the highest risk comes within one month of starting a selective serotonin reuptake inhibitor (SSRI) antidepressant.

Photo credit: Rob, CC BY-NC-SA 2.0

In this study, the researchers compared death from “violent” suicide (e.g., hanging, weapon) to “non-violent” suicide (e.g., poisoning, overdose). Their results indicated that SSRI use was associated with an increased likelihood of using violent means to end one’s life. This comparison is important because the use of violent means is far more likely to result in completed suicide.

Studies have consistently found increased suicide rates associated with taking antidepressants, especially for children and adolescents. One common argument is that the spike in suicide rates just after initiating antidepressants could be due to the underlying severity of depression. However, other recent studies have controlled for the severity of symptoms and still found that those taking antidepressants were up to 2.5 times more likely to attempt suicide than those taking placebo.

The current study only looked at people who had died from suicide, so they could not say whether SSRI use could cause or protect against suicidality in general. The study looked at violent versus non-violent means of suicide, which might indicate who is more likely to die from suicide or who might survive it.

The study looked at forensic autopsy reports in Sweden between 2005 and 2012. The researchers compared those who died from violent suicide with those who died from non-violent suicide (e.g., overdose). Forensic reports included data on whether the person had SSRI levels in their body at the time of death. This data was then linked to the Swedish National Prescription Registry to determine how long the person had been taking the antidepressant. Because the Swedish registries are very thorough, the researchers were able to include in their study almost every person in the country who died from suicide during that time period.

The researchers were also able to control for the presence of other substances (other medications and illegal drugs) at the time of death. Their results demonstrated that the use of these substances was associated with use of SSRIs and with deaths from non-violent suicide.

The researchers conclude that if they hadn’t controlled for these other substances, their presence might have hidden the large effect of SSRI use, making it appear that SSRIs were protective against death from violent suicide.

The researchers write that SSRI use might lead to increased impulsivity and aggressiveness, which could result in the choice of more violent means (and therefore an increased likelihood of completed suicide). However, use of other substances (such as opiates) might lead to reduced impulsivity and aggressiveness, and choice of non-violent means such as overdose instead of violent means. The use of these substances might sometimes cancel out the increased risk of use of violent means from SSRI use.

According to the authors:

“Based on our findings, it cannot be excluded that SSRIs, in particular in users who attempt suicide within the first months of treatment, might increase the risk of choosing a violent method, resulting in a greater risk of fatal outcome than if a non-violent method had been chosen.”

The researchers write that there are “limited” clinical implications for their study. Although they found a fourfold increase in death from violent suicide, the researchers conclude that overall, “the hazards of undertreatment outweigh the risks of therapy.”



Forsman, J., Masterman, T., Ahlner, J., Isacsson, G., & Hedström, A. K. (2019). Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study. European Journal of Clinical Pharmacology, 75, 393–400. (Link)


  1. I’ve known this for a long time. About ten years ago, a town near me had the highest high school suicide rate in the nation. The kids were lighting themselves on fire and jumping in front of trains … very violent suicides. I was probably the only adult in the neighborhood wondering which psych drugs the children had been put on, at that time though.

    I don’t personally believe that “the hazards of undertreatment outweigh the risks of therapy.” Especially since there are not actually any hazards of under treating “invalid” diseases, like the DSM disorders. But it’s good we’re finally discussing that there are “risks of therapy.” Hey, today is my ten year anniversary of the last day I was forced to take a psych drug.

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    • Ten years!!! Congrats!!!

      I agree, too, the idea that under treatment has hazards is completely bogus, because what people need are love and validating support and community resources, not “treatment” via drugs and labels. The mental health community is doing its level best to deny the social determinants of health in favor of an outdated disease model that only benefits the owners and Pharma.

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  2. Well, today’s shrinks would certainly be appalled at the late Gertrude Black, MD, a GP who never used antidepressants for suicidal ideation. She’d give her patients 500mg. of B1, followed by 100mg. every hour until they’d had 500 more mg. of B1. She’d also be amused when shrinks would tell her patients they were glad that the patients were now taking their medications, when they’d actually gone months or years without them (she was an early orthomolecular practitioner, before the word “orthomolecular” was coined).

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  3. Nothing the Mental Health System does is good. Not psychiatry, not drugging, not psychotherapy, not recovery, not the closely affiliated fields of Autism/Aspergers/ADHD/Neurological difference.

    So the only things we need to talk about is how we are going to take actions against this vast Mental Health System.

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    • I think we need to find a lawyer who will bring a class action suit against all “mental health” workers who have misdiagnosed the common adverse effects of the antidepressants as “bipolar.” Since even the DSM-IV-TR pointed this out as malpractice. And we know this type malpractice happened to a million children, not to mention likely millions and millions more adults, based upon Whitaker’s research.

      Right now the scientific fraud based “mental health” workers are celebrating, because the psychiatrists response to Whitaker’s findings, was to take this disclaimer out of the DSM5.

      “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

      We need a lawyer who’ll take this on as a class action lawsuit.

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    • You are talking about legalizing the pathological identity in monotheistic (theological) state ruled by vulgar materialism. From materialistic, apollonic point of view, pathology is evil, because monotheistic man see only evil in his psychological life or, he cannot see it at all. Because he sees only materialistic needs.

      That is why apollonian ego, rational, monotheistic man should never have a power over psyche. It leads only to materialistic psychopathy like – communism, capitalism, psychiatry. All apollonian ego wants, is power and money. For apollonian ego in the center of the psyche is….apollonian ego.

      Psychological man needs real human identity, not diagnosis. And that identity was stolen by monotheistic man and by the age of reason. Psyche needs its stolen image. From psychological point of view, psyche is a value. For apollonian materialists psyche is an enemy and BS. Their identity is too empty, convenient and materialistic to see pathology from the proper angle.

      Apollonians wants only to have convenient life, they do not need pathology, they cannot see its value and meaning. So we must give a power over psyche, to the real father of psychological life, to Hades. Psyche needs Copernicus not false empiricism. Psyche is not a property of medicine, biology. Materialistic, monotheistic man talks about polytheistic man in monotheistic language which is full of hatred. The 2nd dimension cannot see the value of 3rd dimension. They can see only the shadow.
      We must fight with monotheism. Because we know better what psyche is. We must restore the worth of polytheistic identity. Because monotheistic man won’t do it.

      James Hillman quotes-

      My practice tells me I can no longer distinguish clearly between neurosis of self and neurosis of world, psychopathology of self and psychopathology of world. Moreover, it tells me that to place neurosis and psychopathology solely in personal reality is a delusional repression of what is actually, realistically, being experienced.

      Psychoanalysis has to get out of the consulting room and analyze all kinds of things. You have to see that the buildings are anorexic, you have to see that the language is schizogenic, that “normalcy” is manic, and medicine and business are paranoid.

      The word “normal” comes from the Greek norma, which was a carpenter’s square, that right-angled tool for establishing straightness.

      Expectations that are only statistical are no longer human.

      As long as you’re going to create a castle, the psyche can only come in as an invader.

      In my bones, I am afraid of Christian unconsciousness, because, unlike Buddhism, say, or even Judaism, Christianism lives myths deliberately, insisting they are not myths, and this has dreadful paranoid consequences.

      Soul enters only via symptoms, via outcast phenomena like the imagination of artists or alchemy or “primitives,” or of course, disguised as psychopathology. That’s what Jung meant when he said the Gods have become diseases: the only way back for them in a Christian world is via the outcast.

      History is one way of making a gestalt: historical references, figures from the past release the foreground event from being stuck in only what it says it is.

      In Freud’s time we felt oppressed in the family, in sexual situations, in our crazy hysterical conversion symptoms, and where we felt oppressed, there was the repressed. Where do we feel that thick kind of oppression today? In institutions–hospitals, universities, businesses; in public buildings, in filling out forms, in traffic…

      Psychopathic behavior is a fundamentalist behavior: taking fantasies literally and also confusing the literal and the concrete. Now this is just what the Fundamentalist churches support: if your arm offend thee, cut it off. If your nose offend thee, get it straightened.

      The whole world is sick….and you can’t put this right by having a good therapeutic dialogue or finding deeper meanings. It’s not about meaning anymore; it’s about survival.

      Do you see the complete harmony between central dictatorship, fascism, political callousness, and the self-centeredness of the spiritual point of view?

      A terrorist is the product of our education that says that fantasy is not real, that says aesthetics is just for artists, that says soul is only for priests, imagination is trivial or dangerous and for crazies, and that reality, what we must adapt to, is the external world, a world that is dead. A terrorist is a result of this whole long process of wiping out the psyche.

      There is a secret love hiding in each problem.

      Hard to believe, but the hypochondrias are taking care of us, the depressions are slowing us down, obsessions are ways of polishing the image, paranoid suspicions are ways of trying to see through–all these moves of the pathological are ways we are being loved in the peculiar way the psyche works.

      When Freud says, “Where Id was, there shall Ego be”–it is also an extraordinarily greedy statement. He wants to get every last stone out of the quarry. But what about the quarry?

      The psyche is highly flammable material. So we are always wrapping things in asbestos, keeping our images and fantasies at arm’s length because they are so full of love.

      Our life is psychological, and the purpose of life is to make psyche of it, to find connections between life and soul.

      Our gods have become small, save one, and with the exception of a few last conventions of proper names, titles, and places, and the nonsense capitals of corporate abbreviations (nominalism is capitalism, letters as units of exchange), the one magnification persisting as a capital refers to the one person still remaining in a depersonified world: I. Only I and God, one to one, and some say God is dead.

      To mythic consciousness, the persons of the imagination are real.

      When the dominant vision that holds a period of culture together cracks, consciousness regresses into earlier containers, seeking sources for survival which also offer sources of revival.

      By means of personifications my sense of person becomes more vivid for I carry with me at all times the protection of my daimones: the images of dead people who mattered to me, of ancestral figures of my stock, cultural and historical persons of renown and people of fable who provide exemplary images–a wealth of guardians. They guard my fate, guide it, probably are it. “Perhaps–who knows,” writes Jung, “these eternal images are what men mean by fate.” We need this help, for who can carry his fate alone?

      The cooking vessel of the soul takes in everything, everything can become soul; and by taking into its imagination any and all events, psychic space grows.

      There may well be more psychopathology actually going on while transcending than while being immersed in pathologizing.

      Symptoms, not therapists, led this century to soul.

      The healer is the illness and the illness is the healer.

      When we are told what is healthy we are being told what is right to think and feel. When we are told what is mentally ill we are being told what ideas, behavior, and fantasies are wrong.

      Let us see pathologizing as a mode of speech.

      If the fundamental principle of psychological life is differentiation, then no single perspective can embrace psychological life, and norms are the delusions that parts prescribe to one another.

      Pathologizing forces the soul to a consciousness of itself as different from the ego and its life–a consciousness that obeys its own laws of metaphorical enactment in intimate relation with death.

      The alchemists spoke of patience as a first quality of soul and considered soul-making the longest journey, a via longissima. The language is digestion, a vegetable love, depression into still waters.

      Literalism prevents psychologizing by making psychology of it.

      As truths are the fictions of the rational, so fictions are the truths of the imaginal.

      Psychological awareness rises from errors, coincidences, indefiniteness, from the chaos deeper than intelligent control.

      Knowledge makes us able to leave it behind, able to take off down the road of pitfalls in full foolishness, risking even greater windmills still further out, an old knight more and more bold, an old rogue more and more peculiar, ageing into the freedom of our pathology.

      The horizon of the psyche these days is shrunk to the personal, and the new psychology of humanism fosters the little self-important man at the great sea’s edge, turning to himself to ask how he feels today, filling in his questionnaire, counting his personal inventory. He has abandoned intellect and interpreted his imagination in order to become with his “gut experiences” and “emotional problems”; his soul has become equated with these. His fantasy of redemption has shrunk to “ways of coping”; his stubborn pathology, that via regia to the soul’s depths, is cast forth in Janovian screams like swine before Perls, disclosed in a closed Gestalt of group closeness, or dropped in an abyss of regression during the clamber up to Maslovian peaks.

      The psyche moves; but does psychology?

      Now we are called defensive or resistant to the therapeutic process where once we might have been blamed for closing ourselves against God’s grace or turning from His will.

      If our civilization suffers from hybris, from ego inflation and superbia, psychology has done its part. It has been looking at soul in th ego’s mirror, never seeing psyche, always seeing man. And this man has been monotheistic Reformational man, enemy of images.

      Reflection in the mirror of the soul lets one see the madness of one’s spiritual drive, and the importance of this madness.

      The spirit turned toward psyche, rather than deserting it for high places and cosmic love, finds ever further possibilities of seeing through the opacities and obfuscations in the valley. Sunlight enters the vale. The Word participates in gossip and chatter.

      Cure the symptom and lose the God. Had Jacob not grappled with the Daemon he would indeed have not been hurt, and he would not have been Jacob either.

      Economics is our contemporary theology, regardless of how we spend Sunday.

      We now call the destruction of old ideas, politely, a “paradigm shift.” “Catastrophe theory” would be more appropriate. The vitality of a culture depends less on its hopes and its history than on its capacity to entertain willingly the divine and daimonic force of ideas.

      Two insanely dangerous consequences result from raising efficiency to the level of an independent principle. First, it favors short-term thinking–no looking ahead, down the line; and it produces insensitive feeling–no looking around at the life values being lived so efficiently. Second, means become ends; that is, doing something becomes the full justification of doing regardless of what you do.

      Inefficiency becomes a favorite mode of rebellion against the tyranny of efficiency: slowdown, work-to-rule, buck-passing, absenteeism, delayed responses, mislaid documents, unreturned phone calls.

      Anyone who justifies decisions by referring to the bottom line has something to learn from Treblinka.

      For a candidate for political office to campaign on a platform of efficiency in government suggests the infiltration of fascistic ideals. Mussolini made the trains run on time–but at what cost?

      Today we need heroes of descent, not masters of denial, mentors of maturity who can carry sadness, who give love to aging, who show soul without irony or embarrassment.

      Instead of adventuring forward to explore and research unknown territory, control fights a rearguard action, keeping inventory of what has already happened. It likes complete reports. Control, for all its self-assured position of command, relies on a defensive vision, and the traits enumerated–enforced loyalty, exactitude, suspicion of the hidden, watchfulness–are paranoid traits.

      In any system, whether a corporation, a family or the inner arrangements of the human psyche, a vigorous “no” to the good of the whole may serve the good of the whole and increase its power even more than a complaint “yes.”

      Besides policing weapons, we might search for methods of teaching that capture attention and evoke concentration–images, dramas, rituals, rhythms–thereby transferring power back from the weapon to the child’s mind.

      The lead horse does not run because it is whipped.

      Absolutism is not a ruthless ruler, but a ruthless rule–and this we don’t easily remember, for our minds fix upon the figures of czars and crime lords. These images serve to keep the danger of tyranny projected onto Stalin, Genghis Khan and Al Capone, protecting us from the absolutism that can rule the psyche in the guise of fundamentalism in religion, bottom-lineism in business and progress in the sciences.

      Purists are deadly, and so they know all about deadly sins.

      Something always has you in mind.

      “Well, what can I do about the world? This thing’s bigger than me.” That’s the child archetype talking. “All I can do is go into myself, work on my growth, my development, find good parenting, support groups.” This is a disaster for our political world, for our democracy. Democracy depends on intensely active citizens, not children.

      The ideal of growth makes us feel stunted; the ideal family makes us feel crazy.

      We’re not allowed in the street. We have to be careful, pretty correct, not extreme or radical, and not mix it up with our clients and patients out in the world. And this slants our thinking toward white, middle-class psychology.

      You can move to nirvana, but the Gods find out where you go.

      Is there a reality that is not framed or formed? No. Reality is always coming through a pair of glasses, a point of view, a language–a fantasy.

      I won’t accept these simple opposites–either individual self in control or a totalitarian, mindless mob. This kind of fantasy keeps us afraid of community. It locks us up inside our separate selves all alone and longing for connection. In fact, the idea of surrendering to the fascist mob is the result of the separated self. It’s the old Apollonian ego, aloof and clear, panicked by the Dionysian flow.

      Sometimes, the genius seems to show only in symptoms and disorders, as a kind of preventive medicine, holding you back from a false route.

      Picasso said, “I don’t develop; I am.” And the puzzle in therapy is not how did I get this way, but what does my angel want with me?

      Let’s call them “troubles.” Can you imagine a blues singer going on about problems?

      I challenge psychotherapy’s cool green consulting rooms, the soothing images and framed diplomas, because they are calming and cooling the valuable madness in our society so that psychology has become part of Henry Miller’s Air-Conditioned Nightmare, his phrase for the U.S.A.

      Mediocrity is no answer to violence. In fact, it probably invites violence. At least the mediocre and the violent appear together as in the old Western movies–the ruffian outlaw band shooting up main street and the little white church with the little white schoolteacher wringing her hands. To cool violence you need rhythm, humor, tempering; you need dance and rhetoric. Not therapeutic understanding.

      If therapy imagines its task to be that of helping people cope (and not protest), to adapt (and not rebel), to normalize their oddity, and to accept themselves “and work within your situation; make it work for you” (rather than refuse the unacceptable), then therapy is collaborating with what the state wants: docile plebes. Coping simply equals compliance.

      Now when therapy decides to cure the pathology, instead of seeing that the pathology is part of the crack or the broken window, and that something is trying to get in, then it seems to me it’s creating more pathology and keeping the Gods even further away. And then they break in through the whole fucking society.

      The sexual fascination is the soul trying to get out and get into something other than itself.

      If we could recover the imaginal we must first recover its organ, the heart, and its kind of philosophy.

      The heart in the beast is not your heart only: it is a microcosmic sun, a cosmos of all possible experiences that no one can own.

      The transfiguration of matter occurs through wonder.

      The desert is not in Egypt; it is anywhere once we desert the heart.

      Perhaps Konrad Lorenz is wrong, and the counselors wrong too, who seek to find a way beyond aggression. Is it “aggression,” or is it the lion roaring at the enraging desert? Has psychology not missed the native sulphur, neglected Mars who rides a lion, Mars, beloved of Aphrodite, demanding right. Splendor Solis. Sol invictus: Mithra of the heart.

      I find today that patients are more sensitive than the worlds they live in.

      The world, because of its breakdown, is entering a new moment of consciousness: by drawing attention to itself by means of its symptoms, it is becoming aware of itself as a psychic reality.

      Let us imagine the anima mundi [world soul] neither above the world encircling it as a divine and remote emanation of spirit, a world of powers, archetypes, and principles transcendent to things, nor within the material world as its unifying panpsychic life-principle. Rather let us imagine the anima mundi as that particular soul-spark, that seminal image, which offers itself through each thing in its visible form.

      An analyst sitting in his chair all day long is more aware of the faintest flickers of arousal in the seat of his sexuality than of the massive discomfort in the same seat brought by the chair: its wrongly built back, its heat-retaining fabric, its resistant upholstery and formaldehyde glue. His animal sense has been trained to notice only one set of proprioceptions to the exclusion of the psychic reality of the chair. A cat knows better.

      Recognition that the soul is also in the world may awaken us from the psychotherapeutic trance in which we pay a hundred dollars for an hour of subjectivism and no more than $19.95 for a beach chair in whose cold metallic arms and plastic lap reflection actually takes place, day after day.

      By accepting the idea that I am the effect of a subtle buffeting between hereditary and societal forces, I reduce myself to a result. The more my life is accounted for by what already occurred in my chromosomes, by what my parents did or didn’t do, and by my early years now long past, the more my biography is the story of a victim.

      Each person enters the world called.

      So long as the statistics of normalizing developmental psychology determine the standards against which the extraordinary complexities of a life are judged, deviations become deviants.

      There is, after all, something quite beautiful about a life. But you would not think so from reading psychology books.

      Neglect of beauty neglects the Goddess, who then has to steal back into the departments as sexual harassment, into the laboratories as “research” experiments with sex and gender, and into the consulting rooms as seductive assignations.

      Psychology has no self-help manual for its own affliction.

      As civilization subsides into its own waste deposits, it doesn’t matter whether you are feminine or masculine or any composite of them. We all dissolve together.

      To plant a foot firmly on earth–that is the ultimate achievement, and a far later stage of growth than anything begun in your head.

      When your child becomes the reason for your life, you have abandoned the invisible reason you are here.

      Do you really believe that humans invented the wheel out of their big brains alone, or fire, or baskets, or tools? Stones rolled downhill; bolts of fire shot from the sky and out of the earth; birds wove and probed and pounded, as did apes and elephants. The sciences that master nature were taught by nature how it could be mastered.

      To what does the soul turn that has no therapists to visit? It takes its trouble to the trees, to the riverbank, to an animal companion, on an aimless walk through the city streets, a long watch of the night sky. Just stare out the window or boil water for a cup of tea. We breathe, expand, and let go, and something comes in from elsewhere. The daimon in the heart seems quietly pleased, preferring melancholy to desperation. It’s in touch.

      The world is run as much by folly as by wisdom, as much by order as by chaos, but–and this “but” is huge–these accidents may still intend something interesting.

      Anyone who rises in a world that worships success should be suspect, for this is an age of psychopathy.

      Academic psychology, in its eagerness to be as scientific as physics, has one-sidedly chosen the “outside,” so that the soul no longer finds a place in the only field dedicated by its very name to its study. Hence, depth psychology has been more or less kept out of the academics of official psychology….depth psychology is the stone the builders of the academy have rejected.

      The soul can become a reality again only when each of us has the courage to take it as the first reality in our own lives, to stand for it and not just “believe” in it.

      It is the immature who are preoccupied with the search for maturity. And is it not typical of adolescence to see growth and creativity in protean images of “becoming”?

      Loving in safety is the smaller part of loving.

      …Psychoanalysis needs more dissidents, more even than Laing and the antipsychiatric movement; it needs its own “terrorists of soul” in the sense of a radical seeing through of its fixed investments in profession–its banks and insurance, its law courts, its palaces of bureaucracy–to return soul to the world.

      Adler died right out in the street. What a powerful blessing.

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