Paradoxically people being treated for major depression often experience more suicidal thoughts after they start treatment as they move from a state of complete passivity and acquire enough energy to think about suicide while still being profoundly depressed. A team of researchers led by Paola Rucci from the University of Pittsburgh School of Medicine studied this effect in 291 patients taking part in a trial comparing the effectiveness of interpersonal psychotherapy and treatment with serotonin-specific reuptake inhibitors (SSRIs). Of the 231 patients who weren't thinking of killing themselves at the start of the study 13.8% of them did think about ending it all at some point in the study. The participants taking SSRIs took longer to start thinking about killing themselves than those having psychotherapy. Of the 60 patients who were thinking about killing themselves at the start of the study seven showed more suicidal ideation after starting treatment. Overall though all the patients in the study managed their suicidal ideation successfully within the context of the study.
Rucci, P. ... [et al] - Treatment emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial Depression and Anxiety DOI 10.1002/da.20758