Vicodin, Valium, Xanax and Prednisone are among the most widely used prescription drugs linked to suicide. All of them have a high correlation with suicide. Read more from the UChicago Medicine report below.

Researchers reviewed 922 prescription medications taken by almost 150 million people over an 11-year period. Just 10 of these drugs were associated with an increased rate of suicide attempts. On the other hand, forty-four drugs were linked to a decrease in suicide attempts. Many of them carry a “black box” label from the Food and Drug Administration. This label warns of their association with suicidal behavior.

The study was published in the Harvard Data Science Review. It also identifies several drugs with the potential to prevent suicide attempts. Currently, however, they are not used for that purpose. One example is folic acid, a simple vitamin often prescribed to pregnant women.

“There’s an anti-histamine that’s associated with decreases in suicide. There’s a Parkinson’s drug associated with decreases,” said Robert Gibbons, PhD. Gibbons is the Director of the Center for Health Statistics at the University of Chicago. He is also the lead author of the study.

“If those test out in clinical trials to be real effects, we could be using more of these drugs to treat suicidal people.”

Rising Suicide Rates and the Black Box Dilemma

The rate of suicide has been rising for 16 years. It is now the tenth leading cause of death in the United States. Most suicides occur in patients with a psychiatric disorder, such as depression. However, common antidepressant medications like fluoxetine (Prozac) carry the FDA’s black box warning. As a result, use of these medications has decreased despite the benefits they might provide.

How Researchers Tracked Prescription Drugs Linked to Suicide

For the new study, Gibbons and his team developed a statistical tool. It identifies prescription drugs linked to suicide attempts. Specifically, they analyzed data on 922 drugs with more than 3,000 prescriptions. The data came from a database of medical claims from 2003 to 2014. In addition, it contained records of 146 million unique patients from more than 100 U.S. health insurers.

For each person taking each drug, they counted suicide attempts in two windows. These were the three months before filling the prescription and the three months after taking the drug. In turn, this approach allowed them to evaluate each drug individually within a single person. It also showed each drug’s effect on suicide attempts.

“It’s actually a very simple model that answers the question, ‘Does a suicide attempt occur more frequently after taking the drug than before?'” Gibbons said.

Which Prescription Drugs Linked to Suicide Attempts Did the Study Find?

Ultimately, that analysis found 10 prescription drugs linked to suicide attempts with a statistically significant increase. These include the opioid painkiller hydrocodone bitartrate and acetaminophen (Vicodin). The list also includes the anti-anxiety drugs alprazolam (Xanax) and diazepam (Valium), plus the corticosteroid prednisone. Notably, Xanax and Valium are also benzodiazepines associated with dementia risk.

In contrast, a total of 44 drugs showed a decrease in suicide risk. For example, these include a large group of antidepressants with black box warnings. Examples include fluoxetine and escitalopram (Lexapro). The list also includes gabapentin (Neurontin), an anti-convulsant used to treat seizures. Interestingly, it also includes the vitamin folic acid.

A New Approach to Drug Safety Surveillance

Beyond these findings, Gibbons said the model can be used to calculate the risk of any adverse event. This applies to events that happen before and after taking a medication. In fact, the Veterans Administration has already expressed interest in using the tool. Gibbons hopes other large hospital systems and local health agencies will also adopt it. The tool could help them spot prescription drugs linked to suicide risk. It could also guide which drugs to prescribe, especially for patients at risk of suicide.

“What we’ve done is come up with an alternative approach to drug safety surveillance that could be used by any agency, country or formulary,” he said. “We simultaneously did this analysis on all 922 drugs, and from that model we can back out the risks for each one individually.”

Read more from the UChicago Medicine Report.