Navigating Conflicting Data on Medications with Higher Risks of Suicidality and Depression

Megan Maroney, PharmD, BCPP, clinical associate professor, Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey; clinical psychiatric pharmacist, Monmouth Medical Center, Long Branch, NJ, discusses how to navigate data on medications with higher risks of suicidality and depression. This video was filmed at the ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition in Las Vegas, Nevada.

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Megan Maroney, PharmD, BCPP: There is a lot of conflicting data out there. Many of the studies have been contradictory in their results about the true risk of depression and suicidality with many of the medications that have been associated with that risk. It seems like studies that prospective look at this risk and elicit the data prospectively are a better indicator of the true risk. However, a lot of times our randomized controlled trials are small, and it’s hard to detect some of those more rare adverse effects. So, it is a kind of combination of prospective data and large cohort data that really gives us a better picture of the true risk with an individual medication. Many of the medications that we once thought were so high the risk with, when they studied it more comprehensively, the risk does seem lower than what we originally thought. An example of that would be Varenicline. That had a boxed warning for increased risk of neuropsychiatric side effects, but when they studied it further and more data came out, they found that the risk was actually much lower. So the FDA actually commissioned a prospective trial specifically looking at the risk of suicidality, and based on that data they actually scaled back the warning, removed that boxed warning. So there is still a warning, but it’s not that strong boxed warning. So we’re kind of learning more as we go, as more data continues to come out.