Why Are Some Medicines Linked to Suicide?
The EMA took action to ascertain whether certain Novo Nordisk drugs are linked to suicidal thoughts
Stephanie Vine | | 3 min read | Opinion
Updated in July 2024
The Pharmacovigilance Risk Committee of the EMA concluded in April 2024 that available evidence does not suggest a link between GLP-1 receptor agonists (such as Novo Nordisk’s Ozempic, Wegovy, and Saxenda) and an increased risk of suicidal thoughts and thoughts of self harm.
The EMA analyzed around 150 reported cases of suicidal thoughts and self harm relating to the drugs.
In the US, the FDA has also been investigating the matter. The FDA acknowledged a suicide during a clinical trial for Saxenda and recommended that patients be monitored for depression and suicidal thoughts. Indeed, in the US, Wegovy already contains a warning about “increased heart rate and suicidal behavior or thinking.” Ozempic uses the same API, albeit at a lower dose. In January 2024, the FDA said, “preliminary evaluation has not found evidence that use of these medicines causes suicidal thoughts or actions.”
However, the agency continues to investigate. Its statement added, “Because of the small number of suicidal thoughts or actions observed in both people using GLP-1 RAs and in the comparative control groups, we cannot definitively rule out that a small risk may exist; therefore, FDA is continuing to look into this issue.”
Novo Nordisk has reportedly said that its own post surveillance activities do not show a “causal association” between the drugs and self harm.
A number of approved drugs (including, antidepressants) carry warnings about side effects that include depression and suicidal thoughts, particularly in younger patients – with some including the strongest warning mandated by the FDA: a black box warning. For example, a study in suicidal behavior in adults taking paroxetine (Paxil/Seroxat) found an increase in attempted suicide in the drug group compared with placebo – and GSK has faced a major lawsuit connected with the drug.
But exactly how does a medicine trigger suicidal behavior? The link is not well understood. Some people may question whether a drug can ever be fully proven to be responsible for a patient’s suicidal actions, but the links are clear. One disturbing case is that of Sanofi’s anti-obesity medicine Acomplia, which was approved in Europe before being suspended in 2008. The drug was found to almost double the risk of psychiatric disorders in patients versus placebo.
I also came across an informative article that gives examples where medication appears to have contributed to suicide attempts. Some have hypothesized that drugs, such as antidepressants, may energize already suicidal patients to act on impulse or worsen existing symptoms of depression that lead to suicidal thoughts. Some patients may also have other undiagnosed conditions (such as bipolar disorder), where selective serotonin reuptake inhibitors exacerbate psychosis. You can read more here.
Some have also theorized that hormone changes can play a role. For example, premenstrual dysphoric disorder – a disorder that affects neurobiological sensitivity to changes in hormone levels – was found to be linked to suicidal thoughts and actions in a study published last year. Some researchers have also found a link between hormonal contraceptives and suicidal behavior. It’s entirely possible for some medications to affect hormone levels.
When pharma companies develop new medicines, they want them to have a positive impact on patient lives. Novo Nordisk’s Ozempic and Wegovy are used for the treatment of type 2 diabetes and weight management, and Saxenda is indicated for weight management. With obesity increasing worldwide, these drugs may play important roles – and though suicidal behavior as a result of medication is perhaps one of the most difficult side effects to study, study it we must.
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This article was originally published in September 2023.
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